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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).
11271 Results
5985
Managed care and children's behavioral health services in Massachusetts
Type: Journal Article
Year: 2001
Publication Place: United States
Abstract: OBJECTIVE: The authors investigated changes in treatment patterns and costs of care for children after the implementation of the Massachusetts Medicaid carve-out managed care plan. METHODS: The authors hypothesized that after the introduction of managed care, per-child expenditures would be reduced, continuity of care would not improve, and per-child mental health expenditures would undergo larger reductions for disabled children, compared with children enrolled in the Aid to Families With Dependent Children program. Using data from Medicaid and the Massachusetts Department of Mental Health, the authors studied 16,664 Massachusetts Medicaid beneficiaries aged one to 17 years for whom reimbursement claims were submitted for psychiatric or substance use disorder treatment at least once during the two years before the introduction of managed care (1991 to 1992) or during the two years afterward (1994 to 1995). Multivariate analysis was used to estimate changes in probability of admission, and, among patients admitted, to identify factors accounting for variation in length of stay. To assess the variation in expenditures, we regressed the same variables, using the natural logarithm function to transform total mental health expenditures data and inpatient expenditures data to reduce skewness. RESULTS: After the introduction of managed care, per-child expenditures were lower, especially for disabled children, and the Department of Mental Health was used as a safety net for the most seriously ill children without increasing state expenditures. Continuity of care appeared to decline for disabled children. CONCLUSIONS: It is likely that a combination of factors related to the reported changes in patterns of care and expenditures were responsible for the overall per-child expenditures.
Topic(s):
Financing & Sustainability
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, Healthcare Policy
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View the PubMed citation for Managed care and children's behavioral health services in Massachusetts
Reference Links: View the PubMed citation for Managed care and children's behavioral health services in Massachusetts
5987
Management and monitoring of opioid use in pregnancy
Type: Journal Article
Year: 2020
Publication Place: United States
Topic(s):
Healthcare Disparities
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, Opioids & Substance Use
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5989
Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review
Type: Journal Article
Year: 2019
Publication Place: England
Abstract: Background: Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care. Objectives: The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals. Methods: A systematic literature search was performed using the databases PubMed, PsycINFO, Cochrane Library and Web of Science. Selection criteria were a randomized controlled trial of a primary-care-based stepped care intervention, adult samples, publication between 2000 and 2017 and English or German language. Results: Of 1009 search results, 39 studies were eligible. One-third of the trials were conceived for depressive disorders only, one-third for depression and further somatic and/or mental comorbidity and one-third for conditions other than depression. In 39% of the studies comorbidities were explicitly integrated in treatment, mainly via transdiagnostic self-management support, interprofessional collaboration and digital approaches for treatment, monitoring and communication. Most care teams were composed of a primary care physician, a care manager and a psychiatrist and/or psychologist. Due to the heterogeneity of the addressed disorders, no meta-analysis was performed. Conclusions: Several stepped care models in primary care already account for comorbidities, with depression being the predominant target disorder. To determine their efficacy, the identified strategies to account for comorbidities should be investigated within stepped care models for a broader range of disorders.
Topic(s):
Medically Unexplained Symptoms
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View the DOI record for Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review
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View the PubMed citation for Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review5990
Management of depression for people with cancer (SMaRT oncology 1):
Type: Journal Article
Year: 2008
Abstract: Abstract. BACKGROUND: Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer, but evidence to guide its management is scarce. We aimed to assess the efficacy and cost of a nurse-delivered complex intervention that was designed to treat major depressive disorder in patients who have cancer. METHODS: We did a randomised trial in a regional cancer centre in Scotland, UK. 200 outpatients who had cancer with a prognosis of greater than 6 months and major depressive disorder (identified by screening) were eligible and agreed to take part. Their mean age was 56.6 (SD 11.9) years, and 141 (71%) were women. We randomly assigned 99 of these participants to usual care, and 101 to usual care plus the intervention, with minimisation for sex, age, diagnosis, and extent of disease. The intervention was delivered by a cancer nurse at the centre over an average of seven sessions. The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale (range 0 to 4) at 3 months after randomisation. Analysis was by intention to treat. This trial is registered as ISRCTN84767225. FINDINGS: Primary outcome data were missing for four patients. For 196 patients for whom we had data at 3 months, the adjusted difference in mean Symptom Checklist-20 depression score, between those who received the intervention and those who did not, was 0.34 (95% CI 0.13-0.55). This treatment effect was sustained at 6 and 12 months. The intervention also improved anxiety and fatigue but not pain or physical functioning. It cost an additional pound sterling 5278 (US$10 556) per quality-adjusted life-year gained. INTERPRETATION: The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible, acceptable, and potentially cost effective.
Topic(s):
Financing & Sustainability
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View the DOI record for Management of depression for people with cancer (SMaRT oncology 1):
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View the PubMed citation for Management of depression for people with cancer (SMaRT oncology 1):5993
Management of kratom dependence with buprenorphine/naloxone in a veteran population
Type: Journal Article
Year: 2021
Publication Place: United States
Abstract: Background: Kratom is a substance that when ingested produces an opioid-like effect. As kratom continues to gain popularity, increasing numbers of cases of addiction, dependence, and adverse events have been reported, as well as an increase in mortality associated with its use. George E. Wahlen Department of Veterans Affairs Medical Center has been using buprenorphine/naloxone for the treatment of kratom withdrawal and dependence in both primary care and specialty addiction treatment settings in the Veteran population. Cases: We present three cases that describe the use of buprenorphine/naloxone for kratom dependence. For each case, we describe the withdrawal symptoms from kratom, induction and long-term maintenance on buprenorphine/naloxone in kratom dependence, the impact of polysubstance use disorders in management of kratom dependence, and the use of urine drug screens for kratom alkaloids during treatment. Discussion: This case series demonstrates that patients with kratom dependence can effectively be treated with buprenorphine/naloxone. It appears that it is safe to induce buprenorphine/naloxone as early as eight hours after last kratom use and maintenance dosing for kratom use was similar to maintenance doses used in opioid use disorder. Prolonged and continued withdrawal symptoms were reported despite treatment with buprenorphine/naloxone and multiple daily doses of up to 24mg per day may be beneficial for prolonged withdrawal symptoms and for cooccurring pain. Polysubstance use with kratom dependence may require higher levels of care and higher doses of buprenorphine/naloxone. Urine drug screens may be best practice for monitoring kratom alkaloids concentrations and facilities that utilize buprenorphine/naloxone to treat kratom dependence should have testing available. Further research is needed on the impact and the treatment of kratom dependence.
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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Reference Links:
View the DOI record for Management of kratom dependence with buprenorphine/naloxone in a veteran population
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View the PubMed citation for Management of kratom dependence with buprenorphine/naloxone in a veteran population5994
Management of mental health problems by general practitioners in Quebec
Type: Journal Article
Year: 2012
Publication Place: Canada
Abstract: OBJECTIVE: To document the management of mental health problems (MHPs) by general practitioners. DESIGN: A mixed-method study consisting of a self-administered questionnaire and qualitative interviews. An analysis was also performed of Regie de l'assurance maladie du Quebec administrative data on medical procedures. SETTING: Quebec. PARTICIPANTS: Overall, 1415 general practitioners from different practice settings were invited to complete a questionnaire; 970 general practitioners were contacted. A subgroup of 60 general practitioners were contacted to participate in interviews. MAIN OUTCOME MEASURES: The annual frequency of consultations over MHPs, either common (CMHPs) or serious (SMHPs), clinical practices, collaborative practices, factors that either support or interfere with the management of MHPs, and recommendations for improving the health care system. RESULTS: The response rate was 41% (n = 398 general practitioners) for the survey and 63% (n = 60) for the interviews. Approximately 25% of visits to general practitioners are related to MHPs. Nearly all general practitioners manage CMHPs and believed themselves competent to do so; however, the reverse is true for the management of SMHPs. Nearly 20% of patients with CMHPs are referred (mainly to psychosocial professionals), whereas nearly 75% of patients with SMHPs are referred (mostly to psychiatrists and emergency departments). More than 50% of general practitioners say that they do not have any contact with resources in the mental health field. Numerous factors influence the management of MHPs: patients' profiles (the complexity of the MHP, concomitant disorders); individual characteristics of the general practitioner (informal network, training); the professional culture (working in isolation, formal clinical mechanisms); the institutional setting (multidisciplinarity, staff or consultant); organization of services (resources, formal coordination); and environment (policies). CONCLUSION: The key role played by general practitioners and their support of the management of MHPs were evident, especially for CMHPs. For more optimal management of primary mental health care, multicomponent strategies, such as shared care, should be used more often.
Topic(s):
Education & Workforce
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View the PubMed citation for Management of mental health problems by general practitioners in Quebec
Reference Links: View the PubMed citation for Management of mental health problems by general practitioners in Quebec
5995
Management of mood and anxiety disorders in patients receiving opioid agonist therapy: Review and meta-analysis
Type: Journal Article
Year: 2017
Publication Place: England
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Management of mood and anxiety disorders in patients receiving opioid agonist therapy: Review and meta-analysis
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View the PubMed citation for Management of mood and anxiety disorders in patients receiving opioid agonist therapy: Review and meta-analysis5998
Management of opioid painkiller dependence in primary care: Ongoing recovery with buprenorphine/naloxone
Type: Journal Article
Year: 2014
Publication Place: England
Abstract: Opioid painkiller dependence is a growing problem and best-practice management is not well defined. We report a case of a young woman exhibiting dependence on codeine, originally prescribed for myalgic encephalopathy, after escalating use over a 10-year period. In 2012, a consultation with a new general practitioner, who had extensive experience of patients with substance abuse, revealed the underlying dependence. After building trust for 6 months, she was able to admit to medication abuse, and was referred to the community drug and alcohol team. On presentation to the team, the patient had no pain issues and the dihydrocodeine use--600 tablets/week--solely reflected her dependence. The patient successfully underwent rapid induction with buprenorphine/naloxone as opioid substitution treatment over 2 days. She is currently stable, engaged with recovery support services and psychosocial counselling, and has just returned to work. She is maintained on a therapeutic dose of buprenorphine 10 mg/naloxone 2.5 mg.
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Management of opioid painkiller dependence in primary care: Ongoing recovery with buprenorphine/naloxone
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View the PubMed citation for Management of opioid painkiller dependence in primary care: Ongoing recovery with buprenorphine/naloxone5999
Management of Opioid Use Disorder Treatment: An Overview
Type: Journal Article
Year: 2019
Publication Place: United States
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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, Measures
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Reference Links: View the PubMed citation for Management of Opioid Use Disorder Treatment: An Overview