Literature Collection

OBJECTIVE: The authors conducted a scoping review to survey the evidence landscape for studies that assessed outcomes of treating patients with opioid use disorder with methadone in office-based settings. METHODS: Ovid MEDLINE and the Cochrane Database of Systematic Reviews were searched, and reference lists were reviewed to identify additional studies. Studies were eligible if they focused on methadone treatment in office-based settings conducted in the United States or other highly developed countries and reported outcomes (e.g., retention in care). Randomized trials and controlled observational studies were prioritized; uncontrolled and descriptive studies were included when stronger evidence was unavailable. One investigator abstracted key information, and a second verified data. A scoping review approach broadly surveyed the evidence, and therefore study quality was not rated formally. RESULTS: Eighteen studies of patients treated with office-based methadone were identified, including six trials, eight observational studies, and four additional articles discussing use of pharmacies to dispense methadone. Studies on office-based methadone treatment, including primary care-based dispensing, were limited but consistently found that stable methadone patients valued office-based care and remained in care with low rates of drug use; outcomes were similar compared with stable patients in regular care. Office-based methadone treatment was associated with higher treatment satisfaction and quality of life. Limitations included underpowered comparisons and small samples. CONCLUSIONS: Limited research suggests that office-based methadone treatment and pharmacy dispensing could enhance access to methadone treatment for patients with opioid use disorder without adversely affecting patient outcomes and, potentially, inform modifications to federal regulations. Research should assess the feasibility of office-based care for less stable patients.

OBJECTIVES: This study aimed to develop a brief, Veteran-targeted intervention to educate and activate Veteran engagement in patient-centered mental health care and test its feasibility, acceptability, and preliminary efficacy. METHODS: Participatory action research methods were used with Veterans, VA clinicians, and VA researchers to develop a Veteran engagement intervention. Once developed, qualitative interviews were conducted with participants in a ten-person acceptability trial. This was followed by a pilot randomized controlled trial (n = 48) to test feasibility and explore preliminary efficacy. RESULTS: Omnis Salutis is a three session, individual intervention grounded in Motivational Interviewing, which aims to help Veterans identify their well-being goals and be an active leader in their mental health care. Acceptability was confirmed in qualitative interviews, with participants noting that Veterans are socialized to hierarchical provider relationships and Omnis Salutis was an effective method of activating Veterans. Feasibility of interventionist training and intervention delivery was demonstrated both in-person and on the telehealth platform with 41 Veterans completing three sessions of the experimental and control conditions and interventionists demonstrating over 90 % fidelity to the intervention. Though not statistically powered, at three months post-exposure, there were small effect size indicating that Omnis Salutis participants may have greater self-reported involvement in care and lower perceptions of their providers' patient-centeredness than the control. CONCLUSIONS: Omnis Salutis was developed to support recent Veterans preference for multi-faceted mental health care which supports their functional recovery, and VA's efforts to create a patient-centered, Whole Health system of care. PRACTICE IMPLICATIONS: Providers should be aware that Veterans have been socialized in a hierarchical health care system. Veterans may need additional time and education to understand the patient-centered approach and learn new ways of engaging in health care. Further research is needed to determine if Omnis Salutis increases patients' ability to effectively participate in health care encounters and self-care behaviors by increasing their ability to identify and communicate their health care goals and motivations.