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Opioids & SU
The Literature Collection contains over 11,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
11202 Results
9282
Summary of the National Demonstration Project and recommendations for the patient-centered medical home
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was launched in June 2006 as the first national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical record audits, and patient and clinical staff surveys. Peer-reviewed manuscripts from the NDP provide answers to 4 key questions: (1) Can the NDP model be built? (2) What does it take to build the NDP model? (3) Does the NDP model make a difference in quality of care? and (4) Can the NDP model be widely disseminated? We find that although it is feasible to transform independent practices into the NDP conceptualization of a PCMH, this transformation requires tremendous effort and motivation, and benefits from external support. Most practices will need additional resources for this magnitude of transformation. Recommendations focus on the need for the PCMH model to continue to evolve, for delivery system reform, and for sufficient resources for implementing personal and practice development plans. In the meantime, we find that much can be done before larger health system reform.
Topic(s):
Medical Home
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, Healthcare Policy
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Reference Links: 
View the DOI record for Summary of the National Demonstration Project and recommendations for the patient-centered medical home
View DOI Record
View the PubMed citation for Summary of the National Demonstration Project and recommendations for the patient-centered medical home9284
Supervised dosing with a long-acting opioid medication in the management of opioid dependence
Type: Journal Article
Year: 2017
Publication Place: England
Abstract: BACKGROUND: Opioid dependence (OD) is an increasing clinical and public health problem worldwide. International guidelines recommend opioid substitution treatment (OST), such as methadone and buprenorphine, as first-line medication treatment for OD. A negative aspect of OST is that the medication used can be diverted both through sale on the black market, and the unsanctioned use of medications. Daily supervised administration of medications used in OST has the advantage of reducing the risk of diversion, and may promote therapeutic engagement, potentially enhancing the psychosocial aspect of OST, but costs more and is more restrictive on the client than dispensing for off-site consumption. OBJECTIVES: The objective of this systematic review is to compare the effectiveness of OST with supervised dosing relative to dispensing of medication for off-site consumption. SEARCH METHODS: We searched in Cochrane Drugs and Alcohol Group Specialised Register and Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, Web of Science from inception up to April 2016. Ongoing and unpublished studies were searched via ClinicalTrials.gov (www.clinicaltrials.gov) and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (http://www.who.int/ictrp/en/).All searches included non-English language literature. We handsearched references on topic-related systematic reviews. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled clinical trials (CCTs), and prospective controlled cohort studies, involving people who are receiving OST (methadone, buprenorphine) and comparing supervised dosing with dispensing of medication to be consumed away from the dispensing point, usually without supervision. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: Six studies (four RCTs and two prospective observational cohort studies), involving 7999 participants comparing supervised OST treatment with unsupervised treatment, met the inclusion criteria. The risk of bias was generally moderate across trials, but the results reported on outcomes that we planned to consider were limited. Overall, we judged the quality of the evidence from very low to low for all the outcomes.We found no difference in retention at any duration with supervised compared to unsupervised dosing (RR 0.99, 95% CI 0.88 to 1.12, 716 participants, four trials, low-quality evidence) or in retention in the shortest follow-up period, three months (RR 0.94; 95% CI 0.84 to 1.05; 472 participants, three trials, low-quality evidence). Additional data at 12 months from one observational study found no difference in retention between groups (RR 0.94, 95% CI 0.77 to 1.14; n = 300).There was no difference in abstinence at the end of treatment (self-reported drug use) (67% versus 60%, P = 0.33, 293 participants, one trial, very low-quality evidence); and in diversion of medication (5% versus 2%, 293 participants, one trial, very low-quality evidence).Regarding our secondary outcomes, we did not found a difference in the incidence of adverse effects in the supervised compared to unsupervised control group (RR 0.63; 96% CI 0.10 to 3.86; 363 participants, two trials, very low-quality evidence). Data on severity of dependence were very limited (244 participants, one trial) and showed no difference between the two approaches. Data on deaths were reported in two studies. One trial reported two deaths in the supervised group (low-quality evidence), while in the cohort study all-cause mortality was found lower in regular supervision group (crude mortality rate 0.60 versus 0.81 per 100 person-years), although after adjustment insufficient evidence existed to suggest that regular supervision was protective (mortality rate ratio = 1.23, 95% CI = 0.67 to 2.27).No studies reported pain symptoms, drug craving, aberrant opioid-related behaviours, days of unsanctioned opioid use and overdose. AUTHORS' CONCLUSIONS: Take-home medication strategies are attractive to treatment services due to lower costs, and place less restrictions on clients, but it is unknown whether they may be associated with increased risk of diversion and unsanctioned use of medication. There is uncertainty about the effects of supervised dosing compared with unsupervised medication due to the low and very low quality of the evidence for the primary outcomes of interest for this review. Data on defined secondary outcomes were similarly limited. More research comparing supervised and take-home medication strategies is needed to support decisions on the relative effectiveness of these strategies. The trials should be designed and conducted with high quality and over a longer follow-up period to support comparison of strategies at different stages of treatment. In particular, there is a need for studies assessing in more detail the risk of diversion and safety outcomes of using supervised OST to manage opioid dependence.
Topic(s):
Financing & Sustainability
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, Opioids & Substance Use
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Reference Links:
View the DOI record for Supervised dosing with a long-acting opioid medication in the management of opioid dependence
View DOI Record
View the PubMed citation for Supervised dosing with a long-acting opioid medication in the management of opioid dependence9289
Support Models for Addiction Related Treatment (SMART) for pregnant women: Study protocol of a cluster randomized trial of two treatment models for opioid use disorder in prenatal clinics
Type: Journal Article
Year: 2022
Abstract:
INTRODUCTION: The prevalence of opioid use disorder (OUD) in pregnancy increased nearly five-fold over the past decade. Despite this, obstetric providers are less likely to treat pregnant women with medication for OUD than non-obstetric providers (75% vs 91%). A major reason is many obstetricians feel unprepared to prescribe medication for opioid use disorder (MOUD). Education and support may increase prescribing and overall comfort in delivering care for pregnant women with OUD, but optimal models of education and support are yet to be determined. METHODS AND ANALYSIS: We describe the rationale and conduct of a matched-pair cluster randomized clinical trial to compare the effectiveness of two models of support for reproductive health clinicians to provide care for pregnant and postpartum women with OUD. The primary outcomes of this trial are patient treatment engagement and retention in OUD treatment. This study compares two support models: 1) a collaborative care approach, based upon the Massachusetts Office-Based-Opioid Treatment Model, that provides practice-level training and support to providers and patients through the use of care managers, versus 2) a telesupport approach based on the Project Extension for Community Healthcare Outcomes, a remote education model that provides mentorship, guided practice, and participation in a learning community, via video conferencing. DISCUSSION: This clustered randomized clinical trial aims to test the effectiveness of two approaches to support practitioners who care for pregnant women with an OUD. The results of this trial will help determine the best model to improve the capacity of obstetrical providers to deliver treatment for OUD in prenatal clinics. TRIAL REGISTRATION: Clinicaltrials.gov trial registration number: NCT0424039.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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, Opioids & Substance Use
See topic collection
9292
Supporting mental health in South African HIV-affected communities: primary health care professionals' understandings and responses
Type: Journal Article
Year: 2014
Topic(s):
Healthcare Disparities
See topic collection
9293
Supporting nurses to provide primary mental health care
Type: Journal Article
Year: 2011
Publication Place: New Zealand
Topic(s):
Education & Workforce
See topic collection
Reference Links: View the PubMed citation for Supporting nurses to provide primary mental health care
9298
Supporting Physicians and Practice Teams in Efforts to Address the Opioid Epidemic
Type: Journal Article
Year: 2019
Topic(s):
Education & Workforce
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, Opioids & Substance Use
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Reference Links:
View the DOI record for Supporting Physicians and Practice Teams in Efforts to Address the Opioid Epidemic
View DOI Record
View the PubMed citation for Supporting Physicians and Practice Teams in Efforts to Address the Opioid Epidemic9299
Supporting Positive Living and Sexual Health (SPLASH): a clinician and behavioral counselor risk-reduction intervention in a university-based HIV clinic
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: Effective HIV prevention interventions with HIV-positive persons are paramount to stemming the rate of new infections. This paper describes an HIV-clinic-based demonstration project aimed at decreasing patient HIV-transmission risk behaviors and sexually transmitted infections. Systematic, computer-assisted assessment of patient risk aided primary care providers in delivering prevention messages. Patients at greater risk were referred to an HIV Prevention Specialist for behavioral counseling. Patients completed a computerized behavioral staging assessment to self-identify risk behaviors and readiness to change behaviors and counseling messages were individually tailored based on computer assessment. Challenges to project implementation: primary care provider buy-in, patient privacy concerns during risk assessment, and low participation in behavioral counseling. Forty-six percent of persons completing a risk assessment (2,124) were at risk for HIV transmission. Of 121 patients who scheduled counseling appointments, 42% completed at least one session. Despite challenges, successful implementation of a clinic-based prevention intervention is feasible, particularly with attention to patient and provider concerns.
Topic(s):
HIT & Telehealth
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