Literature Collection | Integration Academy

8901

Practice Guidance for Buprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process

Type: Journal Article

Authors: C. M. Farmer, D. Lindsay, J. Williams, A. Ayers, J. Schuster, A. Cilia, M. T. Flaherty, T. Mandell, A. J. Gordon, B. D. Stein

Year: 2015

Publication Place: United States

Abstract: BACKGROUND: Although the number of physicians credentialed to prescribe buprenorphine has increased over time, many credentialed physicians may be reluctant to treat individuals with opioid use disorders due to discomfort with prescribing buprenorphine. Although prescribing physicians are required to complete a training course, many have questions about buprenorphine and treatment guidelines have not been updated to reflect clinical experience in recent years. We report on an expert panel process to update and expand buprenorphine guidelines. METHODS: We identified candidate guidelines through expert opinion and a review of the literature and used a modified RAND/UCLA Appropriateness Method to assess the validity of the candidate guidelines. An expert panel completed 2 rounds of rating, with a meeting to discuss the guidelines between the first and second ratings. RESULTS: Through the rating process, expert panel members rated 90 candidate guideline statements across 8 domains, including candidacy for buprenorphine treatment, dosing of buprenorphine, psychosocial counseling, and treatment of co-occurring depression and anxiety. A total of 65 guideline statements (72%) were rated as valid. Expert panel members had agreement in some areas, such as the treatment of co-occurring mental health problems, but disagreement in others, including the appropriate dosing of buprenorphine given patient complexities. CONCLUSIONS: Through an expert panel process, we developed an updated and expanded set of buprenorphine treatment guidelines; this additional guidance may increase credentialed physicians' comfort with prescribing buprenorphine to patients with opioid use disorders. Future efforts should focus on appropriate dosing guidance and ensuring that guidelines can be adapted to a variety of practice settings.

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8902

Practice Guidance: Drug Screening as a Treatment Tool

Type: Report

Authors: Massachusetts Bureau of Substance Addiction Services

Year: 2013

Topic(s):

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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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8903

Practice Guidelines for Telemental Health with Children and Adolescents

Type: Report

Authors: American Telemedicine Association

Year: 2017

Publication Place: Washington, DC

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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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8904

Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder

Type: Government Report

Authors: Department of Health and Human Services Office of the Secretary

Year: 2021

Publication Place: Washington, DC

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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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8905

Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder (86 Fed. Reg. 22439)

Type: Web Resource

Authors: Department of Health and Human Services Office of the Secretary

Year: 2021

Publication Place: Washington, DC

Abstract:

The Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder provides eligible physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives, who are state licensed and registered by the DEA to prescribe controlled substances, an exemption from certain statutory certification requirements related to training, counseling and other ancillary services (i.e., psychosocial services).

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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.; 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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8906

Practice implications and recommendations for managing codeine misuse and dependence

Type: Journal Article

Authors: M. Bergin, I. Norman, M. Foley, R. Harris, A. Rapca, E. Rich, M. C. Van Hout

Year: 2015

Publication Place: Croatia

Abstract: Codeine, a weak opiate, requires increased pharmacovigilance relating to availability, heterogeneous nature of misuse, dependence and associated harm. A scoping review of literature on codeine was conducted using Arksey & O'Malley's framework (1). Databases searched included PubMed, EBSCO Host, Science Direct, EMBASE, PsycINFO, Cochrane library and Medline from 1994 to 2014. Follow-up search strategies involved hand searching and searching of pharmaceutical, health, medical and drug related websites. Initial zscreening identified 3,105 articles with 475 meeting the inclusion criteria. Eight broad categories organised the literature, data charting and qualitative synthesis. This paper presents implications for practice and makes recommendations to address these issues. Themes identified relate to raising public and practitioner awareness, risk management, dispensing practices and monitoring and surveillance of codeine. Evidence to inform law enforcement, drug surveillance, public health initiatives, harm reduction approaches, pharmacy, clinical and treatment practices is warranted.

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8907

Practice Management and Implementation Science in Integrated Behavioral Health

Type: Journal Article

Authors: William J. Sieber

Year: 2025

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8908

Practice Members' Perspectives on the Implementation of Colorado Integrated Behavioral Health Plus (CIBH +)

Type: Journal Article

Authors: Summers Holtrop, D. Gurfinkel, V. Owen, D. H. Fernald, L. Karra, P. Hosokawa, Brown Levey, L. Tolle, J. Shore

Year: 2026

Abstract:

Integrated Behavioral Health is a key solution in addressing significant problems of access and quality of care. This study assessed practice members' perspectives on the feasibility, acceptability, and appropriateness of an integrated care model called Colorado Integrated Behavioral Health Plus (CIBH +) in a large integrated health system. Seven family medicine practices implemented CIBH + . Practice members completed surveys regarding feasibility, acceptability, and appropriateness (analyzed with descriptive statistics) and semi-structured interviews (analyzed using a grounded theory hermeneutic editing approach). A total of 156 practice members responded to the survey (62% response rate) and 46 participated in interviews (78% response rate). Respondents indicated high levels of agreement about the perceived feasibility, acceptability, and appropriateness of CIBH + . Qualitative themes included: (1) observing the benefits to patients and comprehensive team care reinforced the value of integrating care; (2) supports from teamwork, leadership, and telehealth facilitated implementation; and (3) limitations from role clarity, staffing, space, telehealth, and lack of long-term care options remained challenging for implementation. Identifying the key features of CIBH + may make practical implementation in other settings more feasible to implement and acceptable for patients and care teams to use.

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8909

Practice members’ perspectives on the implementation of colorado integrated behavioral health plus (cibh +)

Type: Journal Article

Authors: Jodi Summers Holtrop, Dennis Gurfinkel, Vanessa Owen, Douglas H. Fernald, Lakshmi Karra, Patrick Hosokawa, Shandra Brown Levey, Lauren Tolle, Jay Shore

Year: 2026

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8910

Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis

Type: Journal Article

Authors: J. Gray, Haji Ali Afzali, J. Beilby, C. Holton, D. Banham, J. Karnon

Year: 2014

Publication Place: England

Abstract: BACKGROUND: Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. METHODS: General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient's depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. RESULTS: Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the low level model. However, this result was highly uncertain, as shown by the confidence intervals. CONCLUSIONS: Classification of patients' depressive state was feasible, but time consuming, using the classification framework proposed. Further validation of the framework is required. Unlike the analyses of diabetes and obesity management, no significant differences in the proportion of depression-free days or health service costs were found between the alternative levels of practice nurse involvement.

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8911

Practice nurse-led proactive care for chronic depression in primary care: a randomised controlled trial

Type: Journal Article

Authors: M. Buszewicz, M. Griffin, E. M. McMahon, K. Walters, M. King

Year: 2016

Publication Place: England

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8912

Practice Predictors of Buprenorphine Prescribing by Family Physicians

Type: Journal Article

Authors: L. E. Peterson, Z. J. Morgan, T. F. Borders

Year: 2020

Publication Place: United States

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8913

Practice strategies to improve compliance and patient self-management

Type: Journal Article

Authors: C. Ruetsch

Year: 2010

Publication Place: United States

Abstract: BACKGROUND: Failure in treating opioid dependence is costly to the patient, the employer, managed care organizations, and the overall health care system. Opioid dependent patients tend to be less productive at work and in society and utilize a great many health care resources. Optimizing outcomes is essential. OBJECTIVE: To introduce the benefit of integrated strategies and patient support in the treatment of opioid dependence. SUMMARY: Health Analytics is currently studying the benefit of HereToHelp, a behavioral support program in which registered nurses or addiction treatment counselors with specialized training in addiction education provide information and encouragement to patients receiving pharmacologic treatment for opioid dependence. A total of 470 physicians in 41 states have been enlisted to participate in this patient support study. The study hypothesis is that patients who receive behavioral support and encouragement will be more compliant with their opioid replacement therapy, leading to better outcomes. Additional treatment strategies are also being developed to minimize the risk of abuse and diversion. Prodrugs and vaccines are also being investigated. CONCLUSION: A coordinated team approach is essential in treating pain patients and opioid-dependent patients. Offering behavior modification in addition to pharmacotherapy and utilizing strategies such as prescription monitoring programs, pain contracts, and screening are all vital components necessary for positive outcomes.

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8914

Practice Transformation? Opportunities and Costs for Primary Care Practices

Type: Journal Article

Authors: J. M. Gill, B. Bagley

Year: 2013

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8915

Practice variation and length of stay in alcohol and drug detoxification centers

Type: Journal Article

Authors: J. N. Jonkman, D. McCarty, H. J. Harwood, S. L. Normand, Y. Caspi

Year: 2005

Publication Place: United States

Abstract: Admissions to 20 publicly funded alcohol and drug detoxification centers in Massachusetts were examined to identify program and patient variables that influenced length of stay. The last admission during fiscal year 1996 was abstracted for patients 18 years of age and older seeking alcohol, cocaine, or heroin detoxification (n=21,311; 29% women). A hierarchical generalized linear model examined the effects of patient and program characteristics on variation in length of stay and tested case-mix adjustments. Program size had the most influence on mean adjusted length of stay; stays were more than 40% longer in detoxification centers with 35 or more beds (7.69 days) than in centers with less than 35 beds (5.42 days). The study highlights the contribution of program size to treatment processes and suggests the need for more attention to program attributes in studies of patient outcomes and treatment processes.

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8916

Practice-based care coordination: A medical home essential

Type: Journal Article

Authors: J. W. McAllister, E. Presler, W. C. Cooley

Year: 2007

Publication Place: United States

Abstract: Families who raise children and youth with special health care needs deserve a medical home. They expect a team approach to health care, with coordination across multiple services and settings. Children, youth, and families benefit from the organization of critical information into written care summaries and action plans. If primary care pediatricians, family physicians, and internists are to achieve optimal health care quality and improvement of existing health care delivery, care coordination will be an essential contributing process to their team approach. Several national health policy recommendations identify care coordination as a cross-cutting intervention to fill the gap between what exists and what is needed in health care today. A practice-based care-coordination model, including a definition and vision for care, a framework of structures and processes, and a position description with specific competencies, is needed. Improvement methodology provides an effective means for health care teams to implement and evaluate practice-based care coordination within their medical home. The improvement approach and model must be flexibly applied to have utility across diverse health care organizations. A medical home team approach, with fully developed practice-based care-coordination services, will enhance health and cost outcomes for children, youth, and families and heighten the professional satisfaction of those delivering health care.

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8917

Practice-Based Guidelines: Buprenorphine in the Age of Fentanyl

Type: Web Resource

Authors: Providers Clinical Support System

Year: 2023

Publication Place: East Providence, RI

Topic(s):

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Disclaimer:

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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8918

Practice-Based Guidelines: Buprenorphine in the Age of Fentanyl

Type: Government Report

Authors: Provider Clinical Support System

Year: 2023

Publication Place: East Providence, RI

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Disclaimer:

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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8919

Practice-Based Interventions Addressing Concomitant Depression and Chronic Medical Conditions in the Primary Care Setting

Type: Journal Article

Authors: L. Watson, H. R. Amick, B. N. Gaynes, K. A. Brownley, S. Thaker, M. Viswanathan, D. E. Jonas

Year: 2012

Publication Place: Rockville (MD)

Abstract: For adults with concomitant depression and chronic medical conditions seen in the primary care setting, to assess the effectiveness of practice-based interventions for improving mental health or medical outcomes. We searched MEDLINE(R), Embase, the Cochrane Library, CINAHL(R), and PsycINFO(R) from inception to December 2011. We identified additional studies from reference lists and technical experts. Two people independently selected, extracted data from, and rated the quality of relevant trials and systematic reviews. We conducted quantitative analyses for outcomes when feasible and reported all results by medical condition when possible. Two reviewers graded the strength of evidence (SOE) using established criteria. We included 24 published articles reporting data from 12 studies (9 randomized controlled trials and 3 preplanned subgroup analyses from a tenth trial). Sample sizes ranged from 55 to 1,001, and study duration ranged from 6 to 60 months. Eleven studies were conducted in the United States (1 in Puerto Rico) and 1 in Scotland. All studies characterized their respective intervention as a form of collaborative care compared with usual or enhanced usual care, and generally involved a care manager with physician supervision; we found no studies describing other types of practice-based interventions. Settings of care for included studies, although rarely characterized, included both open and closed systems. All studies specified depression as the targeted mental health condition. Medical conditions included arthritis, cancer, diabetes, heart disease, HIV, and one or more conditions. Our meta-analyses found that intervention recipients achieved greater improvement than controls in depression symptoms, response, remission, and depression-free days (moderate SOE); satisfaction with care (moderate SOE); and mental and physical quality of life (moderate SOE). Few data were available on outcomes for chronic medical conditions, except for diabetes; only one trial used a medical outcome as the primary outcome. Diabetic patients receiving collaborative care exhibited no difference in diabetes control as compared with control groups (change in HbA1c: weighted mean difference 0.13, 95% CI, -0.22 to 0.48 at 6 months; 0.24, 95% CI, -0.14 to 0.62 at 12 months; low SOE). Collaborative care interventions improved outcomes for depression and quality of life in primary care patients with multiple different medical conditions. Few data were available on medical outcomes, except for HbA1c in diabetes, which showed no difference between treatment and usual care. Future studies should be designed to target a broader range of medical conditions, or clusters of conditions, and should compare variations of practice-based interventions in head-to-head trials.

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8920

Practice-Based Models of Pediatric Mental Health Care

Type: Journal Article

Authors: C. M. Lee, J. Congdon, C. Joy, B. Sarvet

Year: 2024

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