Literature Collection

Background: There is emerging recognition of the unique benefits of implementing screening, brief intervention, and referral to treatment (SBIRT) in pharmacy settings to identify patients who can benefit from services and connecting them to those services.Objectives: This study describes Project Lifeline - a multipronged public health initiative to provide educational and technical support to rural community pharmacies implementing SBIRT for substance use disorder (SUD) and providing harm reduction support.Methods: Eight community pharmacies were recruited. Patients receiving a Schedule II prescription were invited to engage in SBIRT and offered naloxone. Patient screening data and key informant interviews with pharmacy staff on implementation strategy were analyzed.Results: Between 2018-2020, 4,601 adult patients were offered screens and 3,407 screens were completed on 2,881 unique adult patients (51.3% female; <0.01% nonbinary; 95.7% White). Of these unique screens, 107 patients were indicated for brief intervention, 31 accepted the brief intervention; and 12 were given a referral to SUD treatment. Patients who declined SBIRT or who did not want to reduce their use were offered access to naloxone (n = 372). Key informant interviews highlighted the importance of person-centered staff education, role-playing, anti-stigma training, and integrating activities into existing patient-care processes.Conclusion: While ongoing research is needed to characterize the full impact of Project Lifeline on patient outcomes, the reported findings help reinforce the benefits of multipronged public health initiatives that include community pharmacists to address the SUD crisis.

IMPORTANCE: The United States is experiencing a crisis of opioid overdose. In response, the US Department of Health and Human Services has defined a goal to reduce overdose mortality by 40% by 2022. OBJECTIVE: To identify specific combinations of 3 interventions (initiating more people to medications for opioid use disorder [MOUD], increasing 6-month retention with MOUD, and increasing naloxone distribution) associated with at least a 40% reduction in opioid overdose in simulated populations. DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model used a dynamic population-level state-transition model to project outcomes over a 2-year horizon. Each intervention scenario was compared with the counterfactual of no intervention in simulated urban and rural communities in Massachusetts. Simulation modeling was used to determine the associations of community-level interventions with opioid overdose rates. The 3 examined interventions were initiation of more people to MOUD, increasing individuals' retention with MOUD, and increasing distribution of naloxone. Data were analyzed from July to November 2020. MAIN OUTCOMES AND MEASURES: Reduction in overdose mortality, medication treatment capacity needs, and naloxone needs. RESULTS: No single intervention was associated with a 40% reduction in overdose mortality in the simulated communities. Reaching this goal required use of MOUD and naloxone. Achieving a 40% reduction required that 10% to 15% of the estimated OUD population not already receiving MOUD initiate MOUD every month, with 45% to 60%% retention for at least 6 months, and increased naloxone distribution. In all feasible settings and scenarios, attaining a 40% reduction in overdose mortality required that in every month, at least 10% of the population with OUD who were not currently receiving treatment initiate an MOUD. CONCLUSIONS AND RELEVANCE: In this modeling study, only communities with increased capacity for treating with MOUD and increased MOUD retention experienced a 40% decrease in overdose mortality. These findings could provide a framework for developing community-level interventions to reduce opioid overdose death.

The integration of behavioral health and serious mental illness assessment and treatment into primary care remains a challenge. While the increase in telehealth usage due to the COVID-19 pandemic helped reduce a key barrier to access, other challenges remain including a shortage of trained providers and an increased demand for services. A collaboration between ECHO-Chicago and Americares established a unique virtual medical education program that provided training and telementoring using the Project ECHO model with the integration of clinic-wide quality improvement (QI) projects. In this paper, we outline the process of adapting the existing Project ECHO(®) (Extension for Community Health Outcomes) series on behavioral health integration and serious mental illness to fit the needs of Free and Charitable Clinics (FCCs). This project highlights the process and organizational-wide outcomes of creating a partnership between an ECHO hub and a national cross-section of FCCs to create a telehealth program to improve mental healthcare delivery within the FCC space that can be replicated and scaled more broadly. Through this process, we highlight evaluation methods to examine the impact of ECHO series beyond the individual to the clinic-wide level.