Literature Collection

6141

Medical Residents' Experiences With Medically Unexplained Illness and Medically Unexplained Symptoms

Type: Journal Article

Authors: Jennifer Harsh, Jennifer Hodgson, Mark B. White, Angela L. Lamson, Thomas G. Irons

Year: 2016

Publication Place: Thousand Oaks, California

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6142

Medical Student Exposure to Integrated Behavioral Health

Type: Journal Article

Authors: R. J. Choi, R. M. Betancourt, M. P. DeMarco, K. D. W. Bream

Year: 2019

Publication Place: United States

Abstract: OBJECTIVE: Integrated behavioral health (IBH) allows for effective care delivery for patients with mental health and behavioral health disorders in primary care settings. This study assesses the state of exposure current medical students have to the IBH model in family medicine clerkships, in order to augment the readiness of students to participate in IBH as developing professionals. METHODS: Clerkship directors at US and Canadian medical schools with a required family medicine run course (n = 141) were asked to estimate the percentage of students exposed to IBH in their clerkships, as part of the Council of Academic Family Medicine Educational Research Alliance (CERA) 2016 survey. RESULTS: The response rate was 86% (n = 118). Forty-four percent of clerkship directors reported that 0-20% of students are exposed to the IBH model in their clerkships. A comparison of schools with low and high exposure showed no significant differences among clerkship characteristics. CONCLUSIONS: A majority of medical students in the USA and Canada are not exposed to IBH models during their primary care clerkship. Larger systematic studies are needed to elucidate the steps necessary to prepare graduating medical students to collaborate in IBH models.

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6143

Medical treatments for opioid use disorder in Iran: a randomized, double-blind placebo-controlled comparison of buprenorphine/naloxone and naltrexone maintenance treatment

Type: Journal Article

Authors: A. Mokri, M. C. Chawarski, H. Taherinakhost, R. S. Schottenfeld

Year: 2016

Publication Place: England

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6144

Medically Assisted Withdrawal (Detoxification): Considering the Mother-Infant Dyad

Type: Journal Article

Authors: Hendree E. Jones, Mishka Terplan, Marjorie Meyer

Year: 2017

Publication Place: United States

Abstract:

Recommendations for opioid agonist pharmacotherapy and against medically assisted withdrawal were based upon early reports that associated withdrawal with maternal relapse and fetal demise. Data from recent case series have called these recommendations into question. Although these data do not support an association between medically assisted withdrawal and fetal demise, relapse remains a significant clinical concern with reported rates ranging from 17% to 96% (average 48%). Given the high loss to follow-up in these studies, the actual relapse rate is likely even greater. Furthermore, while medically assisted withdrawal is being proposed as a public health strategy to reduce neonatal abstinence syndrome (NAS), current data do not support a reduction in NAS with medically assisted withdrawal relative to opioid agonist pharmacotherapy. Overall, the data do not support either benefit of medically assisted withdrawal or equivalence to opioid agonist pharmacotherapy for the maternal-newborn dyad. Medically assisted withdrawal increases the risk of maternal relapse and poor treatment engagement and does not improve newborn health. Treatment of chronic maternal disease, including opioid agonist disorder, should be directed toward optimal long-term outcome.

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6145

Medically unexplained physical symptoms in primary care: a controlled study on the effectiveness of cognitive-behavioral treatment by the family physician

Type: Journal Article

Authors: I. A. Arnold, M. W. de Waal, J. A. Eekhof, W. J. Assendelft, P. Spinhoven, A. M. van Hemert

Year: 2009

Publication Place: United States

Abstract: BACKGROUND: Disabling medically unexplained physical symptoms occur in 16% of all patients in primary care. OBJECTIVE: The aim of this study was to assess the effectiveness of a cognitive-behavioral intervention by the family physician. METHOD: In a controlled design with detailed information on patient selection, 6,409 patients were screened on somatoform disorder, and 65 participants were allocated to care-as-usual or the experimental condition. RESULTS: After 6 and 12 months, the cognitive-behavioral intervention by trained family physicians was not more effective than care-as-usual. CONCLUSION: Possibly, the intensity of treatment was insufficient for the severe and persistent symptoms that were encountered in primary care.

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6146

Medically unexplained physical symptoms: the feasibility of group cognitive-behavioural therapy in primary care

Type: Journal Article

Authors: I. A. Arnold, A. E. Speckens, A. M. van Hemert

Year: 2004

Publication Place: England

Abstract: OBJECTIVE: The aim of this study was to estimate the number of patients with medically unexplained physical symptoms (MUPS) that could be eligible for group cognitive-behavioural treatment (CBT) and to assess the acceptability of this treatment. METHODS: For 3 months, all consultations of one general practitioner (GP) were screened for MUPS. Patients with MUPS who were considered eligible for group CBT were interviewed and offered treatment. RESULTS: From January to March 1999, 1084 consultations of 796 patients were screened. The GP classified the symptoms of 104 patients aged 25-79 as unexplained. Of these, 71 patients were not considered to be eligible for treatment, mainly due to a psychological attribution of the symptoms. The research interview was offered to 33 patients, 16 of them declined and 12 were interviewed. Seven out of the 12 eligible patients accepted treatment. CONCLUSION: In primary care, 18% of patients aged 25-79 years was estimated to have MUPS. For only a minority of these patients, group CBT was considered suitable and acceptable.

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6147

Medically Unexplained Physical Symptoms: Why Counseling Psychologists Should Care About Them

Type: Journal Article

Authors: Lisa M. McAndrew, Myrna L. Friedlander, David R. Litke, Phillips L. Alison, Justin M. Kimber, Drew A. Helmer

Year: 2019

Publication Place: College Park

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6148

Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study

Type: Journal Article

Authors: L. Wileman, C. May, C. A. Chew-Graham

Year: 2002

Publication Place: England

Abstract: BACKGROUND: Patients presenting in primary care frequently exhibit physical symptoms that may be unrelated to organic pathology. Such symptoms are commonly regarded as products of psychological or emotional problems, and their legitimacy as 'medical' matters is often called into question. OBJECTIVES: Our aim was to explore GPs' attitudes to the management of patients that present with medically unexplained symptoms in primary care. METHODS: Semi-structured interviews were conducted with 15 GPs in North-West England. Interviews were audio-taped and subsequently transcribed and analysed using a constant comparison technique. RESULTS: Subjects conceptualized patients presenting with medically unexplained symptoms as the presentation of psychological distress. They presented problems of control and authority in the consultation, and difficulties in managing this had a negative impact on the doctor-patient relationship. Such consultations were frustrating for the GP and potentially harmful to the patient. CONCLUSION: Patients with medically unexplained symptoms were seen to be presenting with inappropriate symptoms that were a manifestation of emotional or social distress. GPs felt ill-equipped to deal with the presentations and the frustrations they felt and may need help in actively and productively managing these patients.

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6149

Medically unexplained symptoms in family medicine: defining a research agenda. Proceedings from WONCA 2007

Type: Journal Article

Authors: Olde Hartman, L. Hassink-Franke, C. Dowrick, S. Fortes, C. Lam, H. van der Horst, P. Lucassen, E. van Weel-Baumgarten

Year: 2008

Publication Place: England

Abstract: BACKGROUND: Medically unexplained symptoms (MUSs) are frequently presented in primary care. Unfortunately, knowledge of these patients and/or symptoms in primary care is still limited. Available research comes mainly from Europe and North America, while the perspectives of cultures such as Africa, Asia and South America are relatively unknown. To bring cultural perspectives together, a symposium and workshop on MUS in primary care was held at the WONCA World Conference 2007 in Singapore. OBJECTIVE: Main goals of this symposium and workshop-apart from presenting ongoing research and bringing together experts in MUS-were to detect knowledge gaps in MUS and to establish priorities in MUS research. This publication focuses on the proposed research agenda. METHODS: Using a nominal group technique, we generated research topics and set priorities. Research topics were grouped into research themes. RESULTS: Participants' (66 researchers and GPs from 29 nationalities) most important research topics were 'formulating a broadly accepted definition of MUS', 'finding a strategy to recognize MUS better and at an earlier stage', 'studying the value of self-management and empowerment in patients with MUS' and 'finding predictors to decide which strategy will best help the individual patient with MUS'. Priorities in research themes of MUS are as follows: (i) therapeutic options for patients with MUS and (ii) problems in consultations with these patients. CONCLUSIONS: More research on MUS in primary care is needed to improve the consultations with and management of these patients. Internationally primary care conferences are excellent for exchanging ideas and formulating central issues of research.

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6150

Medically unexplained symptoms: perceptions of physicians in primary health care

Type: Journal Article

Authors: T. Woivalin, G. Krantz, T. Mantyranta, K. C. Ringsberg

Year: 2004

Publication Place: England

Abstract: BACKGROUND: Patients presenting with multiple symptoms represent a substantial part of a GP's total work load. At the same time, these patients account for the majority of the people on long-term sick-leave in Sweden today. OBJECTIVE: The aim of this study was to explore GPs' perceptions and ways of managing patients with medically unexplained symptoms (MUS). METHODS: Five focus group discussions were conducted with a total of 27 GPs. In the collection and analysis of data, a phenomenographic approach was used. RESULTS: The GPs described how they used four different approaches to manage patients with MUS: a biomedical, a psychological, an educational and a psychosocial approach. Different approaches were used, depending on the patient and the situation, and the GPs even switched approach when working with the same patient. CONCLUSIONS: In their work with patients with MUS, GPs need support and further training to improve the way the biomedical frame of reference is integrated with the humanistic perspective.

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6151

Medically unexplained symptoms: the need for effective communication and an integrated care strategy

Type: Journal Article

Authors: K. J. Gormley

Year: 2014

Publication Place: England

Abstract: Much is already known about medically unexplained symptoms (MUS) in terms of incidence, presentation and current treatment. What needs to be urgently addressed is a strategy for dealing with patients and their conditions, particularly when they do not fall neatly into medical frameworks or pathologies where the syndrome can be easily explained. This article will consider the provision of health and social care support for patients with MUS within an interprofessional education context. The author will contend that a sensitive and valued service for this large client group is dependent upon services without professional boundaries and practitioners with a clinical interest that can work together and agree an appropriate way forward in terms of care, support and strategic service provision. The article will support the idea that clear guidelines through the National Institute for Health and Care Excellence can offer clear clinical direction for practitioners working in primary and secondary care settings to work together interprofessionally to ensure a seamless and sensitive service for people with this condition.

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6152

Medicare Coverage of Substance Use Disorder Care: A Landscape Review of Benefit Coverage, Service Gaps and a Path to Reform

Type: Report

Authors: Ellen Weber, Deborah Steinberg

Year: 2021

Publication Place: Washington, D.C.

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Grey literature is comprised of materials that are not made available through traditional publishing avenues. Examples of grey literature in the Repository of the Academy for the Integration of Mental Health and Primary Care include: reports, dissertations, presentations, newsletters, and websites. This grey literature reference is included in the Repository in keeping with our mission to gather all sources of information on integration. Often the information from unpublished resources is limited and the risk of bias cannot be determined.

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6153

Medicare Part D Opioid Prescribing Mapping Tool

Type: Web Resource

Authors: Centers for Medicare and Medicaid Services

Year: 2017

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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6154

Medicare Payment for Behavioral Health Integration

Type: Journal Article

Authors: M. J. Press, R. Howe, M. Schoenbaum, S. Cavanaugh, A. Marshall, L. Baldwin, P. H. Conway

Year: 2017

Publication Place: United States

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6155

Medication and Counseling Treatment

Type: Web Resource

Authors: Substance Abuse and Mental Health Services Administration

Year: 2015

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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6156

Medication assisted therapy and recovery homes

Type: Journal Article

Authors: Leonard A. Jason, John M. Majer, Ted J. Bobak, Jack O'Brien

Year: 2022

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6157

Medication assisted treatment (MAT): A dialogue with a multidisciplinary treatment team and their patients

Type: Journal Article

Authors: Lori Holleran Steiker, Kim Comstock, Steve Arechiga, Jade Mena, Melissa Hutchins-Jackson, Katrina Kelly

Year: 2013

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6158

Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder

Type: Journal Article

Authors: C. Wilder, D. Lewis, T. Winhusen

Year: 2015

Publication Place: Ireland

Abstract: BACKGROUND: Increasing use of opioids has led to an increase in the number of pregnant and postpartum women in medication assisted treatment (MAT) for opioid use disorder. METHODS: We (1) conducted a systematic review of published literature on MAT discontinuation (methadone and buprenorphine) in pregnant and postpartum women and (2) determined methadone discontinuation rates in a retrospective cohort (2006-2013) of pregnant and postpartum women in a university affiliated methadone clinic. RESULTS: We found limited generalizable literature reports of discontinuation rates, with a range of prenatal discontinuation rates from 0 to 33% and rates which spanned various prenatal and postnatal periods from 26 to 64%. In our cohort of 229 women, 251 pregnancies were reported, with a prenatal methadone discontinuation rate of 11.0%. Based on a Cox proportional hazards model controlling for age, pregnancy outcome, and duration of treatment prior to delivery, the probability of methadone discontinuation at or before 6 months postpartum was 56.0%. Duration of methadone treatment prior to delivery was inversely associated with risk for postpartum discontinuation of treatment (HR = 0.98, 95% CI (0.96, 0.99)). CONCLUSIONS: We conclude that the postpartum period is a time of increased risk for discontinuation of MAT. More accurate assessment of rates of pre- and postpartum MAT discontinuation, as well as further investigation of factors affecting these rates, is warranted. Development and testing of interventions to encourage early prenatal enrollment in MAT and improve postnatal retention in MAT would benefit pregnant women and new mothers with opioid use disorder.

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6159

Medication Assisted Treatment for Opioid Addiction

Type: Web Resource

Authors: Mark Fisher

Year: 2015

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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6160

Medication Assisted Treatment for Opioid Use Disorders: Overview of the Evidence

Type: Report

Authors: University of Washington Alcohol and Drug Abuse Institute

Year: 2015

Publication Place: http://www.refworks.com/refworks2/default.aspx?r=references|MainLayout::init#

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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