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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
1583
Better practices in collaborative mental health care: an analysis of the evidence base
Type: Journal Article
Year: 2006
Publication Place: Canada
Abstract: OBJECTIVES: To conduct a systematic review of the experimental literature in order to identify better practices in collaborative mental health care in the primary care setting. METHODS: A review of Canadian and international literature using Medline, PsycInfo, Embase, the Cochrane Library, and other databases yielded over 900 related reports, of which, 38 studies met the inclusion criteria. A systematic review and descriptive analysis is presented, with key conclusions and best practices. RESULTS: Successful collaboration requires preparation, time, and supportive structures, building on preexisting clinical relationships. Collaborative practice is likely to be most developed when clinicians are colocated and most effective when the location is familiar and nonstigmatizing for patients. Degree of collaboration does not appear to predict clinical outcome. Enhanced collaboration paired with treatment guidelines or protocols offers important benefits over either intervention alone in major depression. Systematic follow-up was a powerful predictor of positive outcome in collaborative care for depression. A clear relation between collaborative efforts to increase medication adherence and clinical outcomes was not evident. Collaboration alone has not been shown to produce skill transfer in PCP knowledge or behaviours in the treatment of depression. Service restructuring designed to support changes in practice patterns of primary health care providers is also required. Enhanced patient education was part of many studies with good outcomes. Education was generally provided by someone other than the PCP. Collaborative interventions that are part of a research protocol may be difficult to sustain long-term without ongoing funding. Consumer choice about treatment modality may be important in treatment engagement in collaborative care (for example, having the option to choose psychotherapy vs medication). CONCLUSIONS: A body of experimental literature evaluating the impact of enhanced collaboration on patient outcomes-primarily in depressive disorders-now exists. Better practices in collaborative mental health care are beginning to emerge.
Topic(s):
Key & Foundational
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Reference Links: View the PubMed citation for Better practices in collaborative mental health care: an analysis of the evidence base
1584
Better Suicide Screening and Prevention Are Possible
Type: Journal Article
Year: 2016
Publication Place: United States
Topic(s):
Measures
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1586
Beyond abstinence and relapse II: momentary relationships between stress, craving, and lapse within clusters of patients with similar patterns of drug use
Type: Journal Article
Year: 2021
Abstract:
RATIONALE: Given that many patients being treated for opioid-use disorder continue to use drugs, identifying clusters of patients who share similar patterns of use might provide insight into the disorder, the processes that affect it, and ways that treatment can be personalized. OBJECTIVES AND METHODS: We applied hierarchical clustering to identify patterns of opioid and cocaine use in 309 participants being treated with methadone or buprenorphine (in a buprenorphine-naloxone formulation) for up to 16 weeks. A smartphone app was used to assess stress and craving at three random times per day over the course of the study. RESULTS: Five basic patterns of use were identified: frequent opioid use, frequent cocaine use, frequent dual use (opioids and cocaine), sporadic use, and infrequent use. These patterns were differentially associated with medication (methadone vs. buprenorphine), race, age, drug-use history, drug-related problems prior to the study, stress-coping strategies, specific triggers of use events, and levels of cue exposure, craving, and negative mood. Craving tended to increase before use in all except those who used sporadically. Craving was sharply higher during the 90 min following moderate-to-severe stress in those with frequent use, but only moderately higher in those with infrequent or sporadic use. CONCLUSIONS: People who share similar patterns of drug-use during treatment also tend to share similarities with respect to psychological processes that surround instances of use, such as stress-induced craving. Cluster analysis combined with smartphone-based experience sampling provides an effective strategy for studying how drug use is related to personal and environmental factors.
Topic(s):
Education & Workforce
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, Opioids & Substance Use
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1589
Beyond interferon side effects: What residual barriers exist to DAA hepatitis C treatment for people who inject drugs?
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: Recent advances in the efficacy and tolerability of hepatitis C treatments and the introduction of a universal access scheme for the new Direct Acting Antiviral (DAA) therapies in March 2016, has resulted in a rapid increase in the uptake of hepatitis C treatment in Australia. Despite these positive developments, recent data suggest a plateauing of treatment numbers, indicating that more work may need to be done to identify and address ongoing barriers to hepatitis C treatment access and uptake. This paper aims to contribute to our understanding of the ongoing barriers to DAA therapies, with a focus on people who inject drugs. The paper draws on participant interview data from a qualitative research study based on a participatory research design that included a peer researcher with direct experience of both hepatitis C DAA treatment and injecting drug use at all stages of the research process. The study's findings show that residual barriers to DAA treatment exist at personal, provider and system levels and include poor venous access, DAA treatments not considered 'core-business' by opioid substitution treatment (OST) providers, and patients having to manage multiple health and social priorities that interfere with keeping medical appointments such as childcare and poor access to transport services. Further, efforts to increase access to and uptake of DAA hepatitis C treatment over time will require a focus on reducing stigma and discrimination towards people who inject drugs as this remains as a major barrier to care for many people.
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Beyond interferon side effects: What residual barriers exist to DAA hepatitis C treatment for people who inject drugs?
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View the PubMed citation for Beyond interferon side effects: What residual barriers exist to DAA hepatitis C treatment for people who inject drugs?1590
Beyond parity: Primary care physicians' perspectives on access to mental health care
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: About two-thirds of primary care physicians (PCPs) reported in 2004-05 that they could not get outpatient mental health services for patients-a rate that was at least twice as high as that for other services. Shortages of mental health care providers, health plan barriers, and lack of coverage or inadequate coverage were all cited by PCPs as important barriers to mental health care access. The probability of having mental health access problems for patients varied by physician practice, health system, and policy factors. The results suggest that implementing mental health parity nationally will reduce some but not all of the barriers to mental health care.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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Reference Links:
View the DOI record for Beyond parity: Primary care physicians' perspectives on access to mental health care
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View the PubMed citation for Beyond parity: Primary care physicians' perspectives on access to mental health care1592
Beyond screening: a review of pediatric primary care models to address maternal depression
Type: Journal Article
Year: 2016
Publication Place: United States
Abstract: Depression is one of the most debilitating chronic disorders in the United States, affecting 15 million children in homes with depressed mothers, many of whom endure household chaos, inconsistent nurturing, inadequate safety practices, and harsh discipline. Depressed mothers are under diagnosed and undertreated, yet there is broad consensus about the importance of identifying and managing maternal depression, as reflected in recommendations by pediatric and obstetric professional organizations to routinely screen for perinatal depression. Screening was shown to be acceptable to women and most pediatric providers, and adding a screening component need not impair clinic efficiency. Screening, however, is not sufficient, and there are few models in the literature to guide medical practices in implementing successful interventions to identify, treat, and prevent maternal depression, particularly in the pediatric setting. We reviewed the literature and identified six studies that evaluated models for screening and managing mothers' depression in pediatric primary care settings. Some of these interventions have promise, but no studies characterized health outcomes of the depressed mothers and children. We discuss the components of these models, their implementation, and the practice and research needed to create effective pediatrics-based systems to reduce the negative effects of maternal depression on mothers, children, and families.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Beyond screening: a review of pediatric primary care models to address maternal depression
View DOI Record
View the PubMed citation for Beyond screening: a review of pediatric primary care models to address maternal depression1593
Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: The negative consequences of untreated postpartum depression (PD) for both the woman and her infant are well established. The impact of maternal depression has led to recommendations on systematic perinatal depression screening. Unfortunately, large-scale initiatives on PD screening have found no benefit unless systems are in place to facilitate appropriate interventions for women who screen positive. Pediatric primary care has been a focus of efforts to support screening and management of PD because pediatric providers, unlike adult healthcare providers, have the most frequent contact with postpartum women through well-child visits. Well-child visits thus present an unparalleled opportunity to detect and intervene with PD. Literature reviews suggest that specific strategies are feasible within pediatric settings and could benefit both the woman and her child. In this article, we present a stepped care approach for screening and managing PD, integrating common elements found in existing pediatric-based models. A stepped care approach is ideal because PD is a heterogeneous condition, with a range of presentations and hence responsiveness to various interventions. This care pathway begins with systematic screening for depression symptoms, followed by a systematic risk assessment for women who screen positive and care management based on risk profiles and responsiveness. This approach allows pediatric providers to be optimally flexible and responsive in addressing the majority of women with PD within the context of the family-centered medical home to improve child well-being. Challenges to managing PD within pediatrics are discussed, including strategies for addressing them. Implications for research, policy, and practice are discussed.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings
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View the PubMed citation for Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings1594
Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS)
Type: Journal Article
Year: 2003
Publication Place: England
Abstract: Patients commonly present in primary care with symptoms for which no physical pathology can be found. This study is a review of published research on medically unexplained symptoms (MUPS) in primary care. A literature review and qualitative comparison of information was carried out. Four questions were addressed: what is the prevalence of MUPS; to what extent do MUPS overlap with psychiatric disorder; which psychological processes are important in patients with MUPS; and what interventions are beneficial? Neither somatised mental distress nor somatisation disorders, based on symptom counts, adequately account for most patients seen with MUPS. There is substantial overlap between different symptoms and syndromes, suggesting they have much in common. Patients with MUPS may best be viewed as having complex adaptive systems in which cognitive and physiological processes interact with each other and with their environment. Cognitive behavioural therapy and antidepressant drugs are both effective treatments, but their effects may be greatest when the patient feels empowered by their doctor to tackle their problem.
Topic(s):
Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS)
1595
Beyond state scope of practice laws for advanced practitioners: Additional supervision requirements for buprenorphine prescribing
Type: Journal Article
Year: 2022
Publication Place: United States
Topic(s):
Education & Workforce
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, Healthcare Policy
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, Opioids & Substance Use
See topic collection
1596
Beyond symptoms: defining primary care mental health clinical assessment priorities, content and process
Type: Journal Article
Year: 2012
Publication Place: England
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Beyond symptoms: defining primary care mental health clinical assessment priorities, content and process
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View the PubMed citation for Beyond symptoms: defining primary care mental health clinical assessment priorities, content and process1597
Beyond the limits of clinical governance? The case of mental health in English primary care
Type: Journal Article
Year: 2008
Publication Place: England
Abstract: BACKGROUND: Little research attention has been given to attempts to implement organisational initiatives to improve quality of care for mental health care, where there is a high level of indeterminacy and clinical judgements are often contestable. This paper explores recent efforts made at an organisational level in England to improve the quality of primary care for people with mental health problems through the new institutional processes of 'clinical governance'. METHODS: Framework analysis, based on the Normalisation Process Model (NPM), of attempts over a five year period to develop clinical governance for primary mental health services in Primary Care Trusts (PCTs). The data come from a longitudinal qualitative multiple case-study approach in a purposive sample of 12 PCTs, chosen to reflect a maximum variety of organisational contexts for mental health care provision. RESULTS: The constant change within the English NHS provided a difficult context in which to attempt to implement 'clinical governance' or, indeed, to reconstruct primary mental health care. In the absence of clear evidence or direct guidance about what 'primary mental health care' should be, and a lack of actors with the power or skills to set about realising it, the actors in 'clinical governance' had little shared knowledge or understanding of their role in improving the quality of mental health care. There was a lack of ownership of 'mental health' as an integral, normalised part of primary care. CONCLUSION: Despite some achievements in regard to monitoring and standardisation of prescribing practice, mental health care in primary care seems to have so far largely eluded the gaze of 'clinical governance'. Clinical governance in English primary mental health care has not yet become normalised. We make some policy recommendations which we consider would assist in the process normalisation and suggest other contexts to which our findings might apply.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Beyond the limits of clinical governance? The case of mental health in English primary care
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View the PubMed citation for Beyond the limits of clinical governance? The case of mental health in English primary care1598
Beyond the Treatment Box: Perspectives on the Federal Response to Opioid Use, Pregnancy, and Neonatal Abstinence Syndrome
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: : There has been much activity within Federal agencies in response to the opioid epidemic particularly in regards to pregnant women and their infants. Substance Abuse and Mental Health Services Administration's recently released document, Advancing the Care of Pregnant and Parenting Women With Opioid Use Disorder and Their Infants: A Foundation for Clinical Guidance, provides an important and timely guidance. Uptake of the guide should improve quality of care and hopefully help lessen the discrimination experienced by pregnant women with opioid use disorder. However, most pregnant women with addiction do not have access to treatment. This unmet need is large and vexing and only tangentially addressed in the Guide. Future Federal efforts should focus beyond the "treatment box."
Topic(s):
Healthcare Disparities
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, Opioids & Substance Use
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