Literature Collection

IMPORTANCE: Expansion of opioid use disorder treatment is needed, particularly in rural communities. OBJECTIVE: To evaluate technology-assisted buprenorphine (TAB) efficacy (1) over a longer period than previously examined, (2) with the addition of overdose education, and (3) among individuals residing in rural communities. DESIGN, SETTING, AND PARTICIPANTS: Two parallel, 24-week randomized clinical trials were conducted at the University of Vermont between February 1, 2018, and June 30, 2022. Participants were adults with untreated opioid use disorder from nonrural (trial 1) or rural (trial 2) communities. These trials are part of a programmatic effort to develop TAB protocols to improve treatment availability in underserved areas. INTERVENTIONS: Within each trial, 50 participants were randomized to TAB or control conditions. Participants in the TAB group completed bimonthly visits to ingest medication and receive take-home doses via a computerized device. They received nightly calls via an interactive voice response (IVR) system, IVR-generated random call-backs, and iPad-delivered HIV, hepatitis C virus (HCV), and overdose education. Control participants received community resource guides and assistance with contacting resources. All participants received harm reduction supplies and completed monthly assessments. MAIN OUTCOMES AND MEASURES: The primary outcome was biochemically verified illicit opioid abstinence across monthly assessments. Secondary outcomes included self-reported opioid use in both groups and abstinence at bimonthly and random call-back visits, treatment adherence, satisfaction, and changes in HIV, HCV, and overdose knowledge among TAB participants. RESULTS: Fifty individuals (mean [SD] age, 40.6 [13.1] years; 28 [56.0%] male) participated in trial 1, and 50 (mean [SD] age, 40.3 [10.8] years; 30 [60.0%] male) participated in trial 2. Participants in the TAB group achieved significantly greater illicit opioid abstinence vs controls at all time points in both trial 1 (85.3% [128 of 150]; 95% CI, 70.7%-93.3%; vs 24.0% [36 of 150]; 95% CI, 13.6%-38.8%) and trial 2 (88.0% [132 of 150]; 95% CI, 72.1%-95.4%; vs 21.3% [32 of 150]; 95% CI, 11.4%-36.5%). High abstinence rates were also observed at TAB participants' bimonthly dosing visits (83.0% [95% CI, 67.0%-92.0%] for trial 1 and 88.0% [95% CI, 71.0%-95.0%] for trial 2). Treatment adherence was favorable and similar between trials (with rates of approximately 99% for buprenorphine administration, 93% for daily IVR calls, and 92% for random call-backs), and 183 of 187 urine samples (97.9%) tested negative for illicit opioids at random call-backs. iPad-delivered education was associated with significant and sustained increases in HIV, HCV, and overdose knowledge. CONCLUSIONS AND RELEVANCE: In these randomized clinical trials of TAB treatment, demonstration of efficacy was extended to a longer duration than previously examined and to patients residing in rural communities. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03420313.

Objective: Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours; however, to date no integrated prevention programmes address all three risk behaviours. The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Methods: The current study included content analysis of interviews with adolescents in primary care (aged 14-18; n = 25) in the intervention development process, followed by usability and acceptability testing with qualitative interviews among adolescents in primary care (aged 14-18; n = 10) and pediatric primary care providers (n = 11) in the intervention refinement process. All data were collected in the Southeastern U.S.Results: Feedback on Teen Well Check addressed content, engagement and interaction, language and tone, aesthetics, logistics, inclusivity, parent/guardian-related topics, and the application of personal stories. Overall, providers reported they would be likely to use this intervention (5.1 out of 7.0) and recommend it to adolescents (5.4 out of 7.0).Conclusions: These findings suggest preliminary usability and acceptability of Teen Well Check. A randomized clinical trial is needed to assess efficacy.;Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours.The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Providers and adolescents rated Teen Well Check as usable and acceptable, and providers indicated that they would recommend it to their adolescent patients.;eng

OBJECTIVES: Prior to the coronavirus disease 2019 (COVID-19) pandemic, introductions between primary care physicians (PCPs) and specialists were conducted in person. These important meetings were integral to patient care, facilitated care coordination, and improved the managed care of the patient. During COVID-19 and beyond, these important relationships should be fostered via digital means. We aimed to identify opportunities of digital health integration for the optimization of physician integration. STUDY DESIGN: Cross-sectional study. METHODS: Prior to COVID-19, we conducted a survey of PCPs at a large multidisciplinary group with more than 1500 physicians that staffs multiple hospitals within a health system. The survey was sent via email with only 1 reminder. RESULTS: Thirty-six PCPs responded to the survey; 25% (9/36) were very satisfied and 19.4% (7/36) were moderately satisfied with the current in-person introductions. The PCPs found introductions to specialists helpful; 83.7% (31/37) wanted to "put a name to the face," and 64.9% (24/37) wanted to "understand the range of service provided by the specialist." Fifty-one percent (19/37) and 54% (20/37) said "I can better manage patient care and know when to refer to a specialist" and "I learn more about a particular specialist," respectively, with specialist introductions. If made easy, 67.6% (25/37) of PCPs would be interested in TeleConnect to facilitate introductions to specialists. CONCLUSIONS: Referrals between PCPs and specialists have been an integral aspect of medical care within managed care organizations. With the advent of technology during COVID-19, and along with this brief survey, the need for digital means to introduce PCPs and specialists is underscored.