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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
6001
Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic
Type: Journal Article
Year: 2016
Publication Place: England
Abstract: BACKGROUND: Patients, providers, communities and health systems have struggled to achieve balance between access to opioid treatment for chronic pain and its potential harmful consequences: especially misuse, addiction and overdose. We developed an interdisciplinary clinic embedded within primary care (the Opioid Reassessment Clinic-ORC) with the goal of improving the quality of care of patients with co-occurring chronic pain and issues related to opioid safety, efficacy and/or misuse. CASE DESCRIPTIONS: We present three cases referred to the ORC that highlight complex clinical scenarios related to assessment and treatment of patients with chronic pain and issues related to opioid safety, efficacy and misuse. DISCUSSION AND EVALUATION: In the context of the three cases, with respect to assessment, we discuss: making the diagnosis of opioid use disorder; allowing the patient space to endorse lack of efficacy; identification of co-occurring hazardous alcohol use; and recognizing barriers to multimodal pain care. With respect to treatment, we discuss: making a change in treatment with which the patient may not agree; effectiveness of buprenorphine/naloxone for the treatment of chronic pain; responding to low efficacy; and making continued opioid therapy contingent on engagement with substance abuse treatment. CONCLUSIONS: The core components of our approach-biopsychosocial assessment and multimodal treatment planning with an emphasis on promoting functional goals and safety using clear communication and a patient-centered stance-should guide providers in the management of similar clinical scenarios. More evidence is needed to definitively guide specific interventions and points of clinical equipoise.
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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6002
Management of postnatal depression in primary care: A window of opportunity
Type: Journal Article
Year: 2010
Publication Place: England
Topic(s):
Education & Workforce
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Reference Links: 
View the DOI record for Management of postnatal depression in primary care: A window of opportunity
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View the PubMed citation for Management of postnatal depression in primary care: A window of opportunity6006
Managing alcohol use in primary care
Type: Journal Article
Year: 2020
Publication Place: England
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Managing alcohol use in primary care
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View the PubMed citation for Managing alcohol use in primary care6007
Managing behavioral health needs of veterans with Traumatic brain injury (TBI) in primary care
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: Traumatic brain injury (TBI) is a frequent occurrence in the United States, and has been given particular attention in the veteran population. Recent accounts have estimated TBI incidence rates as high as 20 % among US veterans who served in Afghanistan or Iraq, and many of these veterans experience a host of co-morbid concerns, including psychiatric complaints (such as depression and post-traumatic stress disorder), sleep disturbance, and substance abuse which may warrant referral to behavioral health specialists working in primary care settings. This paper reviews many common behavioral health concerns co-morbid with TBI, and suggests areas in which behavioral health specialists may assess, intervene, and help to facilitate holistic patient care beyond the acute phase of injury. The primary focus is on sequelae common to mild and moderate TBI which may more readily present in primary care clinics.
Topic(s):
General Literature
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Reference Links:
View the DOI record for Managing behavioral health needs of veterans with Traumatic brain injury (TBI) in primary care
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View the PubMed citation for Managing behavioral health needs of veterans with Traumatic brain injury (TBI) in primary care6008
Managing Bipolar Disorder in the Primary Care Setting: A Perspective for Mental Health Professionals
Type: Journal Article
Year: 2011
Abstract: Bipolar disorder affects between 1.3 percent and 1.6 percent of the general population. According to available evidence, prevalence rates appear to be even higher in primary care settings. The diagnosis and management of patients with bipolar disorder are potentially complicated by a number of factors, including underdiagnosis due to the predominance of depressive symptoms; high levels of psychiatric comorbidity; a comparatively high suicide rate; continuing controversies in the pharmacological management of the disorder; and a potentially elevated cost-of-care contributed by the prescription of brand-name medications as well as laboratory monitoring at baseline and intermittently for lithium and atypical antipsychotics and serum levels for lithium and some anticonvulsants. All of these factors seem to result in an understandable hesitancy on the behalf of primary care clinicians to diagnose and assume care for these complex patients. Mental health professionals need to remain mindful of these issues when arranging dispositions for patients.
Topic(s):
Education & Workforce
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, Financing & Sustainability
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Reference Links: View the PubMed citation for Managing Bipolar Disorder in the Primary Care Setting: A Perspective for Mental Health Professionals
6009
Managing borderline personality disorder and substance use - an integrated approach
Type: Journal Article
Year: 2011
Publication Place: Australia
Abstract: BACKGROUND Although substance use is a common feature of borderline personality disorder, regular use is associated with greater levels of psychosocial impairment, psychopathology, self harm and suicidal behaviour and leads to poorer treatment outcomes. Management of co-occurring substance use disorder and borderline personality disorder within primary care is further compounded by negative attitudes and practices in responding to people with these conditions, which can lead to a fractured patient-doctor relationship. OBJECTIVE This article provides an overview of how the general practitioner can provide effective support for patients with co-occurring borderline personality disorder and substance use disorder, including approaches to assessment and treatment, the therapeutic relationship, referral pathways and managing risk and chronic suicidality. DISCUSSION Despite the complexities associated with this population, GPs are ideally placed to engage patients with co-occurring borderline personality disorder and substance use disorder in a long term therapeutic relationship, while also ensuring timely referral to other key services and health professionals. To provide the most effective responses to this patient group, GPs need to understand borderline personality disorder and its relationship to substance use, develop an 'explanatory framework' for challenging behaviours, implement mechanisms for reflective practice to manage negative countertransference, as well as learn skills to respond adequately to behaviours which jeopardise treatment retention.
Topic(s):
General Literature
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Reference Links: View the PubMed citation for Managing borderline personality disorder and substance use - an integrated approach
6011
Managing child and adolescent mental health problems in primary care: taking the leap from knowledge to practice
Type: Journal Article
Year: 2011
Publication Place: England
Abstract: In 2009, a conference at Imperial College London brought together experts on the primary care provision of child and adolescent mental health. The following paper highlights various themes from the conference, and particularly focuses on general practice. Despite international and national guidance, child and adolescent mental health provision in primary care is limited in the UK and globally. We argue that primary care services are in fact well placed to assess, diagnose, and manage child and adolescent mental health problems. The barriers to such provision are considered from the perspective of both service users and providers, and the possible ways to overcome such challenges are discussed. The paper is informed by various epidemiological and intervention studies and comparisons between different countries and health systems are explored.
Topic(s):
General Literature
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Reference Links:
View the DOI record for Managing child and adolescent mental health problems in primary care: taking the leap from knowledge to practice
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View the PubMed citation for Managing child and adolescent mental health problems in primary care: taking the leap from knowledge to practice6014
Managing co-occurring substance use and pain disorders
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: The safest pain treatment strategy for an individual at risk or recovering from addiction is a nonopioid and benzodiazepine-free approach. If an opioid treatment is necessary, the extent of the risk can be stratified by the use of a biopsychosocial assessment and opioid screening tools. Individuals at high risk should have the greatest amount of structure and monitoring. A written informed consent and treatment agreement can provide a framework for the patient and the patient's family, as well as the clinician. The structure of treatment should specify only that one prescribing physician will write a limited supply of opioids, without refills, until the analgesic efficacy, adverse events, and goals for functional restoration can be assessed. An additional recommendation is that prescriptions should be filled at the same pharmacy with no refill by phone or opportunity for replacement because of loss, damage, or stolen medications. Additionally, random urine drug screens and PDMP reports obtained will help determine if the patient is taking other substances, as well as monitor the patient's medication use patterns. It is important to assess for risk factors in treating chronic pain with opioids; clinicians need to have a realistic appreciation of the resources available to them and the types of patients that can be managed in their practice. Chronic pain treatment with opioids should not be undertaken in patients who are currently addicted to illicit substances or alcohol. With the support of family and friends, ideally the patient can be motivated to participate in an intensive substance abuse treatment. In patients without an immediate risk, precautionary steps should be taken when prescribing opioids. Clinicians and patients need to review the risk factors for opioid-related problems including younger age, benzodiazepine use, and comorbid conditions such as depression, anxiety, and heavy smoking. Both the provider and the patient need a personal investment in the treatment plan and protocol to increase the safety of opioid treatment. New medications and treatment monitoring are being developed to provide maximal relief for the patient while protecting the public health. The optimal ingredients for safe opioid treatment include a strong provider-patient relationship and clinician training in the assessment and treatment of addiction and pain.
Topic(s):
Opioids & Substance Use
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Reference Links: View the PubMed citation for Managing co-occurring substance use and pain disorders
6015
Managing common mental health disorders in primary care: conceptual models and evidence base
Type: Journal Article
Year: 2005
Publication Place: England
Topic(s):
Healthcare Policy
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Reference Links:
View the DOI record for Managing common mental health disorders in primary care: conceptual models and evidence base
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View the PubMed citation for Managing common mental health disorders in primary care: conceptual models and evidence base6017
Managing Depression among Diverse Older Adults in Primary Care: The BRIGHTEN Program
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: OBJECTIVES: A variety of specific cultural adaptations have been proposed for older adult and minority mental health interventions. The objective of this study was to determine whether the BRIGHTEN Program, an individually tailored, interdisciplinary "virtual" team intervention, would equally meet the needs of a highly diverse sample of older adults with depression. METHODS: Older adults who screened positive for depression were recruited from primary and specialty care settings to participate in the BRIGHTEN program. A secondary data analysis of 131 older adults (37.4% African-American, 29.0% Hispanic, 29.8% Non-Hispanic White) was conducted to explore the effects of demographic variables (race/ethnicity, income and education) on treatment outcome. RESULTS: Compared to baseline, participants demonstrated significant improvements on the SF-12 Mental Health Composite and depression (GDS-15) scores at 6-month follow-up. There were no differences on outcome measures based on race/ethnicity, income or education with one exception-a difference between 12th grade and graduate degree education on SF-12 Mental Health Composite scores. CONCLUSIONS: While not explicitly tailored for specific ethnic groups, the BRIGHTEN program may be equally effective in reducing depression symptoms and improving mental health functioning in a highly socioeconomically and ethnically diverse, community-dwelling older adult population. CLINICAL IMPLICATIONS: Implications for behavioral health integration in primary care are discussed.
Topic(s):
Healthcare Disparities
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Reference Links:
View the DOI record for Managing Depression among Diverse Older Adults in Primary Care: The BRIGHTEN Program
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View the PubMed citation for Managing Depression among Diverse Older Adults in Primary Care: The BRIGHTEN Program6018
Managing depression among ethnic communities: A qualitative study
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: PURPOSE: Clinical care for depression in primary care negotiates a path between contrasting views of depression as a universal natural phenomenon and as a socially constructed category. This study explores the complexities of this work through a study of how family physicians experience working with different ethnic minority communities in recognizing, understanding, and caring for patients with depression. METHODS: We undertook an analysis of in-depth interviews with 8 family physicians who had extensive experience in depression care in 3 refugee patient groups in metropolitan Victoria and Tasmania, Australia. RESULTS: Although different cultural beliefs about depression were acknowledged, the physicians saw these beliefs as deeply rooted in the recent historical and social context of patients from these communities. Traumatic refugee experiences, dislocation, and isolation affected the whole of communities, as well as individuals. Physicians nevertheless often offered medication simply because of the impossibility of addressing structural issues. Interpreters were critical to the work of depression care, but their involvement highlighted that much of this clinical work lies beyond words. CONCLUSIONS: The family physicians perceived working across cultural differences, working with biomedical and social models of depression, and working at both community and individual levels, not as a barrier to providing high-quality depression care, but rather as a central element of that care. Negotiating the phenomenon rather than diagnosing depression may be an important way that family physicians continue to work with multiple, contested views of emotional distress. Future observational research could more clearly characterize and measure the process of negotiation and explore its effect on outcomes.
Topic(s):
Healthcare Disparities
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Reference Links:
View the DOI record for Managing depression among ethnic communities: A qualitative study
View DOI Record
View the PubMed citation for Managing depression among ethnic communities: A qualitative study