Literature Collection

BACKGROUND: Measurement based care (MBC) is a patient-centered approach that is gaining popularity in healthcare systems, particularly in mental health settings. However, attitudes towards MBC vary among mental health clinicians and patients, leading to variable implementation. OBJECTIVE: This systematic review synthesises clinician and patient perspectives on the benefits and drawbacks of measurement-based care (MBC) in psychiatry. STUDY SELECTION AND ANALYSIS: We searched Ovid MEDLINE, EMBASE, EBM Reviews, APA PsychINFO and CINAHL databases from inception to January 2024. After screening 1644 titles and abstracts, 48 full papers were reviewed, and 24 studies were ultimately included. Quality assessment was conducted using the Mixed Methods Appraisal Tool, and key patterns were extracted using thematic analysis. FINDINGS: The review reflects opinions of 901 patients and 2831 clinicians across various settings. Patients valued MBC for enhancing communication, self-awareness and reducing stigma. However, they expressed concerns about the adequacy of measures in reflecting their clinical state and uncertainty about how responses influence treatment decisions. Clinicians appreciated MBC for improving patient involvement, tracking treatment response and enhancing communication efficiency. Concerns included inadequate capture of clinical complexity, potential reporting biases, time constraints, insufficient training and concerns with respect to data usage and privacy. CONCLUSIONS AND CLINICAL IMPLICATIONS: While patients and clinicians recognise significant benefits, including enhanced communication, improved insight and more structured clinical decision-making, they also identify important limitations. These include concerns about the adequacy of scales to capture complex clinical presentations, potential impacts on the therapeutic alliance and increased administrative burden. Moving forward, successful integration of MBC into routine care will require addressing these challenges through improved clinician training, clear guidelines for interpretation, greater transparency with respect to how data will be used and more seamless integration with existing clinical workflows. PROSPERO REGISTRATION NUMBER: PROSPERO CRD420250651562.

BACKGROUND: Opioid misuse is a significant public health crisis. The aim sought to identify potential gaps in opioid care in primary care practices. METHODS: American Academy of Family Physicians (AAFP) offered a monthly online educational series to seven U.S. practices. Practices were asked to complete up to 50 chart reviews for visits during two periods: February-April, 2019, and February-April, 2022. Each chart had to have an ICD-10 diagnosis of opioid misuse, opioid dependence, or opioid use. Chart reviews consisted of 14 questions derived from an American Academy of Addiction Psychiatry (AAAP) Performance in Practice activity, and then, scored based on practices' responses. Descriptive statistics and binary logistic and multinomial regressions were used. RESULTS: Both periods had 173 chart reviews (total: 346) from the six practices. Most chart reviews were for patients with a diagnosis of opioid dependence (2019: 90.2%; 2022: 83.2%). Three questions for assessing OUD treatment behaviors had high levels of documentation across both time periods (>85%): other drug use, treatment readiness, and treatment discussion. DISCUSSION: Results show a gap in the treatment of patients with OUD in primary care across several clinical practice recommendations. CONCLUSIONS: Expanding OUD treatment integration to primary care remains the most promising effort to combat the opioid crisis.

BACKGROUND: Patients may spike urine samples with buprenorphine during office-based opioid treatment to simulate adherence to prescribed buprenorphine, potentially to conceal diversion of medications. However, routine immunoassay screens do not detect instances of spiking, as these would simply result in a positive result. The aim of this study was to report on the experience of using quantitative urine testing for buprenorphine and norbuprenorphine to facilitate the identification of urine spiking. METHODS: This is a retrospective chart review of 168 consecutive patients enrolled in outpatient buprenorphine treatment at an urban academic medical setting between May 2013 and August 2014. All urine samples submitted were subjected to quantitative urine toxicology testing for buprenorphine and norbuprenorphine. Norbuprenorphine-to-buprenorphine ratio of less than 0.02 were further examined for possible spiking. Demographic and clinical variables were also extracted from medical records. Clinical and demographic variables of those who did and did not spike their urines were compared. Statistically significant variables from the univariate testing were entered as predictors of spiking in a regression analysis. RESULTS: A total of 168 patients were included, submitting a total of 2275 urine samples. Patients provided on average 13.6 (SD = 9.9) samples, and were in treatment for an average 153.1 days (SD = 142.2). In total, 8 samples (0.35%) from 8 patients (4.8%) were deemed to be spiked. All of the samples suspected of spiking contained buprenorphine levels greater than 2000 ng/mL, with a mean norbuprenorphine level of 11.9 ng/mL. Spiked samples were submitted by 6 patients (75.0%) during the intensive outpatient (IOP) phase of treatment, 2 patients (25.0%) during the weekly phase, and none from the monthly phase. Regression analysis indicated that history of intravenous drug use and submission of cocaine-positive urine samples at baseline were significant predictors of urine spiking. CONCLUSIONS: Even though only a small number of patients were identified to have spiked their urine samples, quantitative testing may help identify urine spiking during office-based opioid treatment with buprenorphine.