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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).
11248 Results
11181
Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment
Type: Journal Article
Year: 2016
Publication Place: England
Abstract: BACKGROUND: The increase in opioid overdose deaths has become a national public health crisis. Naloxone is an important tool in opioid overdose prevention. Distribution of nasal naloxone has been found to be a feasible, and effective intervention in community settings and may have potential high applicability in the emergency department, which is often the initial point of care for persons at high risk of overdose. One safety net hospital introduced an innovative policy to offer take-home nasal naloxone via a standing order to ensure distribution to patients at risk for overdose. The aims of this study were to examine acceptance and uptake of the policy and assess facilitators and barriers to implementation. METHODS: After obtaining pre-post data on naloxone distribution, we conducted a qualitative study. The PARiHS framework steered development of the qualitative guide. We used theoretical sampling in order to include the range of types of emergency department staff (50 total). The constant comparative method was initially used to code the transcripts and identify themes; the themes that emerged from the coding were then mapped back to the evidence, context and facilitation constructs of the PARiHS framework. RESULTS: Acceptance of the policy was good but uptake was low. Primary themes related to facilitators included: real-world driven intervention with philosophical, clinician and leadership support; basic education and training efforts; availability of resources; and ability to leave the ED with the naloxone kit in hand. Barriers fell into five general categories: protocol and policy; workflow and logistical; patient-related; staff roles and responsibilities; and education and training. CONCLUSIONS: The actual implementation of a new innovation in healthcare delivery is largely driven by factors beyond acceptance. Despite support and resources, implementation was challenging, with low uptake. While the potential of this innovation is unknown, understanding the experience is important to improve uptake in this setting and offer possible solutions for other facilities to address the opioid overdose crisis. Use of the PARiHS framework allowed us to recognize and understand key evidence, contextual and facilitation barriers to the successful implementation of the policy and to identify areas for improvement.
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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11183
Why It's Inappropriate Not to Treat Incarcerated Patients with Opioid Agonist Therapy
Type: Journal Article
Year: 2017
Publication Place: United States
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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Reference Links: 
View the DOI record for Why It's Inappropriate Not to Treat Incarcerated Patients with Opioid Agonist Therapy
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View the PubMed citation for Why It's Inappropriate Not to Treat Incarcerated Patients with Opioid Agonist Therapy11187
Why there must be room for mental health in the medical home
Type: Journal Article
Year: 2008
Topic(s):
Financing & Sustainability
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, Medical Home
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Reference Links: View the PubMed citation for Why there must be room for mental health in the medical home
11188
Wide Variation and Overprescription of Opioids After Elective Surgery
Type: Journal Article
Year: 2017
Abstract: OBJECTIVE: We aimed to identify opioid prescribing practices across surgical specialties and institutions. BACKGROUND: In an effort to minimize the contribution of prescription narcotics to the nationwide opioid epidemic, reductions in postoperative opioid prescribing have been proposed. It has been suggested that a maximum of 7 days, or 200?mg oral morphine equivalents (OME), should be prescribed at discharge in opioid-na�ve patients. METHODS: Adults undergoing 25 common elective procedures from 2013 to 2015 were identified from American College of Surgeons National Surgical Quality Improvement Program data from 3 academic centers in Minnesota, Arizona, and Florida. Opioids prescribed at discharge were abstracted from pharmacy data and converted into OME. Wilcoxon Rank-Sum and Kruskal-Wallis tests assessed variations. RESULTS: Of 7651 patients, 93.9% received opioid prescriptions at discharge. Of 7181 patients who received opioid prescriptions, a median of 375 OME (interquartile range 225-750) were prescribed. Median OME varied by sex (375 men vs 390 women, P = 0.002) and increased with age (375 age 18-39 to 425 age 80+, P < 0.001). Patients with obesity and patients with non-cancer diagnoses received more opioids (both P < 0.001). Subset analysis of the 5756 (75.2%) opioid-na�ve patients showed the majority received >200 OME (80.9%). Significant variations in opioid prescribing practices were seen within each procedure and between the 3 medical centers. CONCLUSIONS: The majority of patients were overprescribed opioids. Significant prescribing variation exists that was not explained by patient factors. These data will guide practices to optimize opioid prescribing after surgery.
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Wide Variation and Overprescription of Opioids After Elective Surgery
View DOI Record
View the PubMed citation for Wide Variation and Overprescription of Opioids After Elective Surgery11189
Wide Variation Found in Care of Opioid-Exposed Newborns
Type: Journal Article
Year: 2017
Publication Place: United States
Topic(s):
Education & Workforce
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, Healthcare Disparities
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, Opioids & Substance Use
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Reference Links: View the PubMed citation for Wide Variation Found in Care of Opioid-Exposed Newborns
11190
Widespread pain and depression are key modifiable risk factors associated with reduced social participation in older adults: A prospective cohort study in primary care
Type: Journal Article
Year: 2016
Publication Place: United States
Abstract: In older adults, reduced social participation increases the risk of poor health-related quality of life, increased levels of inflammatory markers and cardiovascular disease, and increased mortality. Older adults frequently present to primary care, which offers the potential to deliver interventions at the point of care to increase social participation. The aim of this prospective study was to identify the key modifiable exposures that were associated with reduced social participation in a primary care population of older adults.The study was a population-based prospective cohort study. Participants (n = 1991) were those aged >/=65 years who had completed questionnaires at baseline, and 3 and 6-year follow-ups. Generalized linear mixed modeling framework was used to test for associations between exposures and decreasing social participation over 6 years.At baseline, 44% of participants reported reduced social participation, increasing to 49% and 55% at 3 and 6-year follow-up. Widespread pain and depression had the strongest independent association with reduced social participation over the 6-year follow-up period. The prevalence of reduced social participation for those with widespread pain was 106% (adjusted incidence rate ratio 2.06, 95% confidence interval 1.72, 2.46), higher than for those with no pain. Those with depression had an increased prevalence of 82% (adjusted incidence rate ratio 1.82, 95% confidence interval 1.62, 2.06). These associations persisted in multivariate analysis.Population ageing will be accompanied by increasing numbers of older adults with pain and depression. Future trials should assess whether screening for widespread pain and depression, and targeting appropriate treatment in primary care, increase social participation in older people.
Topic(s):
Healthcare Disparities
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11193
Willingness to pay for depression treatment in primary care
Type: Journal Article
Year: 2003
Publication Place: United States
Abstract: OBJECTIVE: The authors analyzed data from 615 depressed primary care patients to determine their willingness to pay for depression treatment. METHODS: A sample of 615 adult patients from four primary care clinics participated in a randomized controlled trial of a disease management program for depression in primary care. Participants were asked at baseline interviews and six-month follow-up interviews how much they would be willing to pay per month for a six-month treatment that would eliminate their symptoms of depression. Multiple regression analyses were used to estimate the association between demographic and clinical factors and willingness to pay for depression treatment and to examine changes. RESULTS: The mean amount that participants were willing to pay for depression treatment at baseline was $270+/-187 per month, or about 9 percent of the participants' household income. Willingness to pay was significantly associated with household income and with the severity of depressive symptoms. Over six months, the amount that participants were willing to pay decreased along with their severity of depressive symptoms. CONCLUSIONS: The amount that participants were willing to pay was comparable to that reported for the treatment of other chronic medical disorders and higher than the actual cost of depression treatment. Measurements of willingness to pay may be a promising method for assessing the value of treatments for common mental disorders.
Topic(s):
Financing & Sustainability
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Reference Links: View the PubMed citation for Willingness to pay for depression treatment in primary care
11200
Without Wasting a Word: Extreme Improvements in Efficiency and Accuracy Using Computerized Adaptive Testing for Mental Health Disorders (CAT-MH)
Type: Journal Article
Year: 2019
Publication Place: United States
Abstract:
PURPOSE OF REVIEW: We review recent literature on the adaptive assessment of complex mental health disorders and provide a detailed comparison of classical test theory and adaptive testing based on multidimensional item response theory. RECENT FINDINGS: Adaptive tests for a wide variety of mental health traits (e.g., depression, anxiety, mania, substance misuse, suicidality) are now available in a cloud-based environment. These tests have been validated in a variety of settings against lengthy structured clinical interviews with excellent results and even higher reliability than fixed-length tests. Applications include screening and assessments in emergency departments, psychiatric and primary care clinics, student health clinics, perinatal medicine clinics, child welfare settings, and the judicial system. The future of mental health measurement will be based on automated screening and assessments. Adaptive tests will provide increased precision of measurement and decreased burden of measurement. Integration into the electronic health record is important and now easily accomplished.
Topic(s):
Healthcare Disparities
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, Measures
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