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Opioids & SU
The Literature Collection contains over 10,000 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).
10858 Results
9381
The diagnostic challenges presented by patients with medically unexplained symptoms in general practice
Type: Journal Article
Year: 2008
Publication Place: Norway
Abstract: OBJECTIVE: To describe the complexity of somatizing patients' symptomatology and the difficulties involved in the diagnostic process. DESIGN. Cross-sectional study of patients with medically unexplained symptoms. SETTING: Basque Health Service primary care centres in Bizkaia, Spain. SUBJECTS: The study comprised 156 patients selected at random from a list of 468 patients who had presented, over the course of their lives, six or more medically unexplained somatic symptoms for females and four or more for males, identified retrospectively by their practitioners. MAIN OUTCOME MEASURES: Physicians interviewed these patients using the somatoform symptoms section of the Composite International Diagnostic Interview (CIDI), and the Primary Care Evaluation of Mental Disorders (PRIME-MD). The Medical Outcomes Survey Short Form 36 (SF-36) was filled in at home. Organic diseases whose diagnosis was established during the previous year were included in the study by consulting patients' medical records. RESULTS: Patients were found to have a median of three medically explained and 12 medically unexplained symptoms. Mental disorders were found in 83% of cases, associated with other morbidity categories in 78%. The predictive value of symptoms was lower than 26% for diagnosing broad disease categories. CONCLUSIONS: These results depict an extremely difficult scenario for dichotomous diagnostic strategies aimed at classifying patients' symptoms as either organic or functional. Rather than struggling to choose one of these hypotheses, it is suggested that both of them should always be addressed concurrently.
Topic(s):
Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for The diagnostic challenges presented by patients with medically unexplained symptoms in general practice
9384
The Drug Abuse Screening Test preserves its excellent psychometric properties in psychiatric patients evaluated in an emergency setting
Type: Journal Article
Year: 2017
Publication Place: England
Topic(s):
Opioids & Substance Use
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9386
The e-Mental Health Consultation Service: providing enhanced primary-care mental health services through telemedicine
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: This article describes the University of California, Davis Medical Center eMental Health Consultation Service, a program designed to integrate tele-mental health clinical services, provider-to-provider consultation, and provider distance education. During the first year of operation, consultations were provided for 289 cases. The most common diagnoses among children were for attention-deficit hyperactivity disorder-spectrum problems. Among the adult patients, mood disorders were most common. A convenience sample of 33 adult patients who completed the SF-12 health status measure showed significant improvements in mental health status at 3-6 months of follow-up. This model of comprehensive rural outpatient primary mental health care delivered at a distance shows promise for wider application and deserves further study.
Topic(s):
HIT & Telehealth
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, Medically Unexplained Symptoms
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Reference Links:
View the DOI record for The e-Mental Health Consultation Service: providing enhanced primary-care mental health services through telemedicine
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View the PubMed citation for The e-Mental Health Consultation Service: providing enhanced primary-care mental health services through telemedicine9388
The Eastern North Carolina opioid prescribers project: a model continuing medical education workshop
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: The decision to prescribe opioid medications is complex. Physicians often struggle to balance the risks of medication diversion and abuse with the benefits of pain management. Nationally, more than 40 percent of primary care physicians report difficulty in discussing the possibility of prescription medication abuse with patients and more than 90 percent fail to detect symptoms of substance abuse. Continuing medical education workshops were developed in Eastern North Carolina to mitigate problems with opioid prescriptions. Attendance at these workshops suggests that prescribers are interested in improving opioid prescribing practices and reducing patient risk. Presurvey data indicate that prescribers are knowledgeable about screening tools and they consider patient risk factors for misuse.
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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Reference Links: View the PubMed citation for The Eastern North Carolina opioid prescribers project: a model continuing medical education workshop
9389
The economic burden of neonatal abstinence syndrome in the United States
Type: Journal Article
Year: 2017
Publication Place: England
Topic(s):
Financing & Sustainability
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, Healthcare Disparities
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, Opioids & Substance Use
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Reference Links:
View the DOI record for The economic burden of neonatal abstinence syndrome in the United States
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View the PubMed citation for The economic burden of neonatal abstinence syndrome in the United States9390
The Economic Burden of Opioid Abuse: Updated Findings
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: BACKGROUND: Opioid pain relievers can be highly effective in providing relief for patients suffering from pain. At the same time, prescription opioid abuse, dependence, overdose, and poisoning (hereinafter "abuse") have become a national public health concern. Opioid abuse is also costly: previous estimates of the annual excess costs of opioid abuse to payers range from approximately $10,000 to $20,000 per patient. OBJECTIVES: To (a) provide a comprehensive, current estimate of the economic burden of opioid abuse to commercial payers and (b) explore the drivers of these excess costs of abuse. METHODS: Administrative claims from beneficiaries covered by large self-insured companies throughout the United States were used to identify patients diagnosed with opioid abuse, dependence, and overdose/poisoning ("abuse") between 2012 and 2015. Sample selection criteria identified patients most likely to be misusing opioids. Abusers and nonabuser controls were matched using propensity scores. Excess health care costs were assessed over the 18-month study period. Drivers of excess costs were then evaluated by place of service and medical condition (identified as 3-digit ICD-9-CM groupings). RESULTS: 9,342 matched abuser/nonabuser pairs were analyzed. Relative to nonabusers, abusers had significantly higher annual health care resource utilization, leading to $14,810 in per-patient incremental annual health care costs. Excess costs began accumulating 5 months before the formal, incident diagnosis of abuse, driven by alcohol and nonopioid substance abuse. Major drivers of excess costs of abuse included opioid and other substance abuse disorders, mental health conditions, and painful conditions. Many patients had diagnoses for other substance abuse that predated their opioid abuse diagnoses. CONCLUSIONS: Opioid abuse imposes a substantial economic burden on payers and often occurs in the context of other substance abuse. Poly-substance abuse often precedes the diagnosis of opioid abuse. DISCLOSURES: This study was funded by Purdue Pharma. Mayne is an employee of Purdue Pharma. Kirson, Scarpati, and Birnbaum are employees of Analysis Group, which received funding from Purdue Pharma to conduct this study. Enloe and Dincer were employees of Analysis Group at the time this research was conducted. Study concept and design were contributed by Kirson, Birnbaum, Mayne, and Scarpati, along with Enloe and Dincer. Enloe and Dincer took the lead in data collection, along with Birnbaum and assisted by Kirson and Scarpati. Data interpretation was performed by all the authors. The manuscript was written and revised by Kirson and Scarpati, along with Mayne and Birnbaum.
Topic(s):
Opioids & Substance Use
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, Financing & Sustainability
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9391
The economic cost of chronic fatigue and chronic fatigue syndrome in UK primary care
Type: Journal Article
Year: 2003
Publication Place: England
Abstract: BACKGROUND: Chronic fatigue and chronic fatigue syndrome are most often encountered in primary care settings. Given the disabling nature of chronic fatigue it may have a substantial impact on service use and costs as well as on employment. This study estimates this impact. METHOD: Patients presenting to general practitioners with unexplained chronic fatigue were recruited to the study. Service use over a 3 month period was measured and lost employment recorded. These data were used to estimate economic costs. Patients with chronic fatigue syndrome were compared to patients with only chronic fatigue using a multiple regression model with sample differences controlled. RESULTS: The mean total cost of services and lost employment across the sample was Pound Sterling1906 for the 3-month period with formal services accounting for 9.3% of this figure. Service use was higher for patients with chronic fatigue syndrome compared to those with chronic fatigue alone. Total 3-month costs were on average higher for chronic fatigue syndrome (Pound Sterling3515 v. Pound Sterling1176) but when sample differences were taken account of the mean difference was reduced to Pound Sterling1406 (P = 0.086). Over 90% of the cost was accounted for by care provided by friends and family members and by lost employment. Patients with dependants had significantly higher costs than those with none and costs were also significantly higher for greater levels of functional impairment. CONCLUSION: Chronic fatigue imposes substantial economic costs on society, mainly in the form of informal care and lost employment. Treatments need to be developed which recognize these impacts.
Topic(s):
Financing & Sustainability
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Reference Links: View the PubMed citation for The economic cost of chronic fatigue and chronic fatigue syndrome in UK primary care
9393
The economics of depression in primary care: de-fragmentation in the Oregon Medicaid market
Type: Journal Article
Year: 2006
Topic(s):
Healthcare Policy
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Reference Links:
View the DOI record for The economics of depression in primary care: de-fragmentation in the Oregon Medicaid market
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View the PubMed citation for The economics of depression in primary care: de-fragmentation in the Oregon Medicaid market9394
The economics of integrated depression care: the University of Michigan study
Type: Journal Article
Year: 2006
Topic(s):
General Literature
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Reference Links:
View the DOI record for The economics of integrated depression care: the University of Michigan study
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View the PubMed citation for The economics of integrated depression care: the University of Michigan study9396
The Effect of a Payer-Mandated Decrease in Buprenorphine Dose on Aberrant Drug Tests and Treatment Retention Among Patients with Opioid Dependence
Type: Journal Article
Year: 2016
Publication Place: United States
Topic(s):
Opioids & Substance Use
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9398
The effect of behavioral health consultation on the care of depression by primary care clinicians
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: PURPOSE: The aim of this study is to assess the impact of an integrated care model, called the Behavioral Health Consultation model, in the delivery of care for depression in an urban Federally Qualified Health Center, and to gauge the receptiveness of primary care clinicians to increasing their responsibility for the mental health care of their patients. METHODS: We reviewed electronic medical records to measure referral rates to mental health specialty care, patient engagement in care, management of psychotropic medications, and initiation of antidepressant medication, comparing data from the year prior to program implementation to that from the third year post-implementation. Clinician attitudes were assessed using an online anonymous questionnaire. RESULTS: Statistically significant findings included post-implementation increases in the use of standardized measures of depression, documentation of behavioral goals and patient visits to the primary care clinician (increased engagement), decreases in initiation rates of antidepressant medications, and decreases in referrals to mental health specialty care. No significant difference was found in rates of dosage changes or change to new medications among patients who were already on psychiatric medications. Clinicians reported near universal acceptance of the behavioral health consultation program and willingness to increase their role in managing patient mental health issues. CONCLUSIONS: This study demonstrates that a behavioral health consultation program in an urban community health center can improve adherence to evidence-based indicators in the care of depression, making it possible to manage the majority of patients presenting with depression in the primary care setting.
Topic(s):
HIT & Telehealth
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Reference Links: View the PubMed citation for The effect of behavioral health consultation on the care of depression by primary care clinicians
9399
The effect of context in rural mental health care: Understanding integrated services in a small town
Type: Journal Article
Year: 2017
Publication Place: England
Topic(s):
Healthcare Disparities
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Reference Links: View the PubMed citation for The effect of context in rural mental health care: Understanding integrated services in a small town
9400
The effect of improving primary care depression management on employee absenteeism and productivity. A randomized trial
Type: Journal Article
Year: 2004
Topic(s):
Education & Workforce
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