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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
10821
Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders
Type: Journal Article
Year: 2016
Publication Place: United States
Abstract: OBJECTIVES: Rapidly escalating rates of heroin and prescription opioid use have been widely observed in rural areas across the United States. Although US Food and Drug Administration-approved medications for opioid use disorders exist, they are not routinely accessible to patients. One medication, buprenorphine, can be prescribed by waivered physicians in office-based practice settings, but practice patterns vary widely. This study explored the use of a learning collaborative method to improve the provision of buprenorphine in the state of Vermont. METHODS: We initiated a learning collaborative with 4 cohorts of physician practices (28 total practices). The learning collaborative consisted of a series of 4 face-to-face and 5 teleconference sessions over 9 months. Practices collected and reported on 8 quality-improvement data measures, which included the number of patients prescribed buprenorphine, and the percent of unstable patients seen weekly. Changes from baseline to 8 months were examined using a p-chart and logistic regression methodology. RESULTS: Physician engagement in the learning collaborative was favorable across all 4 cohorts (85.7%). On 6 of the 7 quality-improvement measures, there were improvements from baseline to 8 months. On 4 measures, these improvements were statistically significant (P < 0.001). Importantly, practice variation decreased over time on all measures. The number of patients receiving medication increased only slightly (3.4%). CONCLUSIONS: Results support the effectiveness of a learning collaborative approach to engage physicians, modestly improve patient access, and significantly reduce practice variation. The strategy is potentially generalizable to other systems and regions struggling with this important public health problem.
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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10822
Using a multi-level approach to implement a primary care mental health (PCMH) program
Type: Journal Article
Year: 2010
Publication Place: United States
Topic(s):
General Literature
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Reference Links: 
View the DOI record for Using a multi-level approach to implement a primary care mental health (PCMH) program
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View the PubMed citation for Using a multi-level approach to implement a primary care mental health (PCMH) program10823
Using buprenorphine for outpatient opioid detoxification
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: The Drug Addiction Treatment Act of 2000 (DATA 2000) was established to create a new paradigm for medication-assisted treatment of persons with opiate addiction in the United States. Before enactment of DATA 2000, the use of opioid medications to treat patients with opioid addiction was permissible only in federally approved treatment programs, ie, "methadone clinics." The only medications permitted were Schedule II drugs (eg, methadone hydrochloride and l-alpha-acetylmethadol [LAAM]), which could only be dispensed, not prescribed. Under provisions of DATA 2000, qualified physicians in a medical office and other appropriate settings outside the opioid treatment program system may prescribe and/or dispense Schedule III, IV, and V opioid medications for treating persons with opioid addiction if such medications have been specifically approved by the US Food and Drug Administration for that indication. Opioid addiction treatment programs were commonly known as methadone clinics. Such programs now may also dispense buprenorphine hydrochloride and the buprenorphine hydrochloride-naloxone combination.
Topic(s):
Opioids & Substance Use
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, Healthcare Policy
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Reference Links: View the PubMed citation for Using buprenorphine for outpatient opioid detoxification
10827
Using community engagement to implement evidence-based practices for opioid use disorder: A data-driven paradigm & systems science approach
Type: Journal Article
Year: 2021
Topic(s):
Opioids & Substance Use
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10829
Using distance education to promote the transfer of motivational interviewing skills among behavioral health professionals
Type: Journal Article
Year: 2004
Publication Place: United States
Abstract: This study evaluated the effectiveness of distance education for training behavioral health professionals. Five live video workshops that covered key elements of Motivational Interviewing (MI) were delivered. The programs occurred a month apart, each 3 hours long. The programs used compressed video, transmitting the video signal through telephone lines. The audience was staff at substance abuse treatment organizations throughout the state of Arizona. Participants completed assessments regarding their training experiences, knowledge and self-efficacy in MI, and their satisfaction with the training, prior to, during, and subsequent to the workshops. Participation in the five workshops varied; the first workshop had the largest attendance of 351, the fourth the lowest of 92; 145 participants attended all five workshops. Participants expressed moderate levels of satisfaction with most aspects of the training, although some expressed frustration with interrupted audio or video signals during the programs. The handouts and videotaped examples of MI were identified as the more helpful aspects of the training. Participants reported statistically significant improvements in their self-perceived knowledge and skills. They demonstrated a statistically significant but clinically insignificant increase in knowledge. A small group of participants provided audiotapes of actual counseling sessions. These participants demonstrated minimal improvement in skills across the study that were not statistically significant. These results are discussed in terms of their implications for future research in the use of distance education as a technology transfer tool in the addiction treatment profession.
Topic(s):
Education & Workforce
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10830
Using electronic health record-based tools to screen for bipolar disorder in primary care patients with depression
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: PURPOSE: National guidelines recommend screening all persons with depression for bipolar disorder (BPD); one way to facilitate screening is through the use of electronic health records (EHRs). This study examined the impact of an EHR-based screening and decision support tool on diagnosis and treatment of BPD among patients diagnosed with depression in primary care offices. METHODS: This nonrandomized, controlled trial was conducted in a national network of offices using EHRs. The intervention included a screening instrument and other tools for diagnosis and management of BPD, which were embedded into the EHR. This instrument automatically activated when a patient with a diagnosis of depression but no diagnosis of BPD was seen in the office. The primary outcomes were the rates of new diagnoses of BPD and prescription of new BPD medications during the 6-month study period (April to October 2009). RESULTS: Twenty-one offices with 75 clinicians and 8355 adult patients with depression composed the intervention group, whereas 17 offices with 81 clinicians and 8799 adult patients with depression served as the comparison group. The screening tool was used with 47.5% of intervention patients, of whom 2.5% scored at high or very high risk for BPD. Intervention patients were more likely than comparison patients to be newly diagnosed with BPD (1.11% vs. 0.36%; P < .01) and be prescribed new BPD medications (1.85% vs. 1.19%; P < .01). CONCLUSIONS: The study suggests that EHR-based tools can be useful for screening and management of BPD for patients with depression in primary care offices.
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Using electronic health record-based tools to screen for bipolar disorder in primary care patients with depression
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View the PubMed citation for Using electronic health record-based tools to screen for bipolar disorder in primary care patients with depression10831
Using enhanced and integrated services to improve response to standard methadone treatment: changing the clinical infrastructure of treatment networks
Type: Journal Article
Year: 2010
Publication Place: United States
Topic(s):
Opioids & Substance Use
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10833
Using evidence-based quality improvement methods for translating depression collaborative care research into practice
Type: Journal Article
Year: 2010
Publication Place: United States
Topic(s):
General Literature
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Reference Links:
View the DOI record for Using evidence-based quality improvement methods for translating depression collaborative care research into practice
View DOI Record
View the PubMed citation for Using evidence-based quality improvement methods for translating depression collaborative care research into practice10834
Using financial incentives to promote shared mental health care
Type: Journal Article
Year: 2001
Publication Place: Canada
Abstract: OBJECTIVES: To consider the most common primary care reimbursement structures, to identify incentives inherent in each, and to discuss how each could be used to encourage a shared-care approach to treating mental disorders at the primary care level. METHOD: Three major financial reimbursement models--fee-for-service, capitation, and blended payment mechanisms--are examined. Each is considered in terms of its risk-sharing elements and the consequent incentives. We offer several scenarios to illustrate how the shared-care practice model might be encouraged under each financing mechanism. RESULTS: The current fee-for-service system does not encourage shared care. For wide adoption of the shared-care practice model, there must be a change in the reimbursement system's incentives. While none of the financing mechanisms offers a perfect solution, each has potential. Each, however, must be carefully tailored to its environment. CONCLUSIONS: Financial considerations are just one aspect to achieving shared care. Nevertheless, in designing a system to encourage collaborative, coordinated care for those suffering from mental illness, decision makers should be wary of creating or maintaining obstacles (financial or otherwise) to provision of accessible, high-quality care.
Topic(s):
Financing & Sustainability
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Reference Links: View the PubMed citation for Using financial incentives to promote shared mental health care
10836
Using implementation facilitation to implement primary care mental health integration via clinical video telehealth in rural clinics: protocol for a hybrid type 2 cluster randomized stepped-wedge design
Type: Journal Article
Year: 2019
Publication Place: England
Abstract: BACKGROUND: Integrating mental health providers into primary care clinics improves access to and outcomes of mental health care. In the Veterans Health Administration (VA) Primary Care Mental Health Integration (PCMHI) program, mental health providers are co-located in primary care clinics, but the implementation of this model is challenging outside large VA medical centers, especially for rural clinics without full mental health staffing. Long wait times for mental health care, little collaboration between mental health and primary care providers, and sub-optimal outcomes for rural veterans could result. Telehealth could be used to provide PCMHI to rural clinics; however, the clinical effectiveness of the tele-PCMHI model has not been tested. Based on evidence that implementation facilitation is an effective implementation strategy to increase uptake of PCMHI when delivered on-site at larger VA clinics, it is hypothesized that this strategy may also be effective with regard to ensuring adequate uptake of the tele-PCMHI model at rural VA clinics. METHODS: This study is a hybrid type 2 pragmatic effectiveness-implementation trial of tele-PCMHI in six sites over 24 months. Tele-PCMHI, which will be delivered by clinical staff available in routine care settings, will be compared to usual care. Fidelity to the care model will be monitored but not controlled. We will use the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to evaluate the patient-level clinical effectiveness of tele-PCMHI in rural VA clinics and also to evaluate the fidelity to and outcomes of the implementation strategy, implementation facilitation. The proposed study will employ a stepped-wedge design in which study sites sequentially begin implementation in three steps at 6-month intervals. Each step will include (1) a 6-month period of implementation planning, followed by (2) a 6-month period of active implementation, and (3) a final period of stepped-down implementation facilitation. DISCUSSION: This study will evaluate the effectiveness of PCMHI in a novel setting and via a novel method (clinical video telehealth). We will test the feasibility of using implementation facilitation as an implementation strategy to deploy tele-PCMHI in rural VA clinics. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT02713217 . Registered on 18 March 2016.
Topic(s):
Healthcare Disparities
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, HIT & Telehealth
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10837
Using implementation interventions and peer recovery support to improve opioid treatment outcomes in community supervision: Protocol
Type: Journal Article
Year: 2021
Topic(s):
Education & Workforce
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, Healthcare Disparities
See topic collection
, Opioids & Substance Use
See topic collection
10839
Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies
Type: Journal Article
Year: 2018
Publication Place: England
Abstract:
BACKGROUND: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption. METHODS: We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis. RESULTS: Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability. CONCLUSIONS: Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.
Topic(s):
Education & Workforce
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, Healthcare Disparities
See topic collection
, HIT & Telehealth
See topic collection