Literature Collection | Integration Academy

1701

Barriers to engaging people who use drugs in harm reduction services during the COVID-19 pandemic: A mixed methods study of syringe services program perspectives

Type: Journal Article

Authors: Elizabeth J. Austin, Maria A. Corcorran, Elsa S. Briggs, Madeline C. Frost, Czarina N. Behrends, Alexa M. Juarez, Noah D. Frank, Elise Healy, Stephanie M. Prohaska, Paul A. LaKosky, Shashi N. Kapadia, David C. Perlman, Bruce R. Schackman, Don C. Des Jarlais, Emily C. Williams, Sara N. Glick

Year: 2022

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1702

Barriers to implementation of opioid overdose prevention programs in Ohio

Type: Journal Article

Authors: E. L. Winstanley, A. Clark, J. Feinberg, C. M. Wilder

Year: 2016

Publication Place: United States

Abstract: BACKGROUND: Nationally, overdose fatalities have reached epidemic proportions. Ohio has one of the highest overdose death rates in the country, as well as high rates of prescription opioid trafficking. METHODS: A cross-sectional self-report survey of opioid overdose prevention programs (OOPPs) in Ohio was conducted between August and October 2014 to characterize programs and ascertain barriers to successful implementation. A 91% response rate was achieved with 18 programs participating in the study. RESULTS: The first Ohio OOPP opened in August 2012, a second program opened in 2013, and the remaining programs began in 2014. All of the programs distribute nasal naloxone and provide overdose prevention education, and 89% (n = 16) provide overdose kits for free. Six OOPPs are funded by the Ohio Department of Health, 3 programs are funded by a local health foundation, and several other public and private funding sources were reported. The OOPPs have funding to distribute a combined total of 8,670 overdose kits and had distributed 1998 kits by October 2014. The OOPPs reported 149 overdose reversals. Fifteen programs (83%) reported implementation barriers that were categorized as stigma-, cost-, staffing-, legal, regulatory, and client-related problems. Legislative changes aimed at removing some of the obstacles to distribution and lay administration of naloxone have recently been enacted in Ohio. CONCLUSIONS: OOPPs have rapidly expanded in Ohio during the past 3 years. Although recent legislative changes have addressed some of the reported implementation barriers, stigma and the cost of naloxone remain significant problems.

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1703

Barriers to implementing screening and brief interventions in general practice: findings from a qualitative study in Norway

Type: Journal Article

Authors: P. Nygaard, O. G. Aasland

Year: 2011

Publication Place: England

Abstract: AIMS: The qualitative component of this mixed methods study aimed at obtaining more in-depth information about the barriers of implementation of screening and brief interventions (SBI) in general practice identified in the quantitative component by giving general practitioners (GPs) the opportunity to discuss and report on the particular difficulties they experience in relation to identification and treatment of alcohol problems in their daily work. METHODS: Focus-group interviews were performed with seven groups of GPs in different parts of Norway, encompassing 40 participants. The interviews were transcribed and analyzed using the QDA Miner software. RESULTS: The analysis revealed five major groups of factors influencing GPs' reluctance to use SBI for alcohol problems: (a) perception of alcohol problems, (b) integration of SBI into existing routines, (c) prevention vs. treatment, (d) structural issues and (e) the relationship between practitioner and patient. Discussion: The analysis showed that problems of implementing SBI in general practice are a complex issue. The quantitative part of the project revealed a strong association between knowledge/self-efficacy and the use of SBI. However, in the qualitative study, we were able to look in more detail at some of the findings from the first part. Even if the lack of knowledge of SBI was still significant, the five factors identified in this study appeared important for the GPs' decisions to use SBI in individual cases.

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1704

Barriers to initiating depression treatment in primary care practice

Type: Journal Article

Authors: P. A. Nutting, K. Rost, M. Dickinson, J. J. Werner, P. Dickinson, J. L. Smith, B. Gallovic

Year: 2002

Abstract: Abstract. OBJECTIVE AND DESIGN: This study used qualitative and quantitative methods to examine the reasons primary care physicians and nurses offered for their inability to initiate guideline-concordant acute-phase care for patients with current major depression. PARTICIPANTS AND SETTING: Two hundred thirty-nine patients with 5 or more symptoms of depression seeing 12 physicians in 6 primary care practices were randomized to the intervention arm of a trial of the effectiveness of depression treatment. Sixty-six (27.6%) patients identified as failing to meet criteria for guideline-concordant treatment 8 weeks following the index visit were the focus of this analysis. METHODS: The research team interviewed the 12 physicians and 6 nurse care managers to explore the major reasons depressed patients fail to receive guideline-concordant acute-phase care. This information was used to develop a checklist of barriers to depression care. The 12 physicians then completed the checklist for each of the 64 patients for whom he or she was the primary care provider. Physicians chose which barriers they felt applied to each patient and weighted the importance of the barrier by assigning a total of 100 points for each patient. Cluster analysis of barrier scores identified naturally occurring groups of patients with common barrier profiles. RESULTS: The cluster analysis produced a 5-cluster solution with profiles characterized by patient resistance (19 patients, 30.6%), patient noncompliance with visits (15 patients, 24.2%), physician judgment overruled the guideline (12 patients, 19.3%), patient psychosocial burden (8 patients, 12.9%), and health care system problems (8 patients, 12.9%). The physicians assigned 4,707 (75.9%) of the 6,200 weighting points to patient-centered barriers. Physician-centered barriers accounted for 927 (15.0%) and system barriers accounted for 566 (9.1%) of weighting points. Twenty-eight percent of the patients not initiating guideline-concordant acute-stage care went on to receive additional care and met criteria for remission at 6 months, with no statistical difference across the 5 patient clusters. CONCLUSIONS: Current interventions fail to address barriers to initiating guideline-concordant acute-stage care faced by more than a quarter of depressed primary care patients. Physicians feel that barriers arise most frequently from factors centered with the patients, their psychosocial circumstances, and their attitudes and beliefs about depression and its care. Physicians less frequently make judgments that overrule the guidelines, but do so when patients have complex illness patterns. Further descriptive and experimental studies are needed to confirm and further examine barriers to depression care. Because few untreated patients improve without acute-stage care, additional work is also needed to develop new intervention components that address these barriers.

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1705

Barriers to Integrated Medication-Assisted Treatment for Rural Patients With Co-Occurring Disorders: The Gap in Managing Addiction

Type: Journal Article

Authors: C. Snell-Rood, R. A. Pollini, C. Willging

Year: 2021

Publication Place: United States

Abstract:

OBJECTIVE: Guidelines for treatment of opioid use disorder stipulate for mental health assessment and the option for treatment alongside medication for opioid use disorder (MOUD). Yet efforts to expand MOUD treatment capacity have focused on expanding the workforce of buprenorphine providers. This article aims to describe the processes facilitating and impeding integrated care for rural patients with co-occurring opioid use disorder and mental health conditions. METHODS: Qualitative interviews were conducted with primary care and specialty providers (N=26) involved in integrated care through the state's hub-and-spoke system and with system-level stakeholders (N=16) responsible for expanding access to MOUD in rural California. RESULTS: Rural primary care providers struggled to offer adequate mental health resources to patients with co-occurring conditions because of personnel shortages and inadequate availability of telehealth. Efforts to intensify care through referral to county mental health systems and private community providers were thwarted by access barriers. The bifurcated nature of treatment systems resulted in inadequate training in integrated care and the deprioritization of mental health in patient evaluations. CONCLUSIONS: Significant system-level barriers undermine the implementation of integrated MOUD in rural areas, potentially increasing the suffering of residents with co-occurring conditions and intensifying burnout among providers.

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1706

Barriers to integrated primary care and specialty mental health services: Perspectives from Latinx and non-Latinx White primary care patients

Type: Journal Article

Authors: Elizabeth A. Anastasia, Linda E. Guzman, Ana J. Bridges

Year: 2023

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1707

Barriers to Integrating Mental Health Services in Community-Based Primary Care Settings in Mexico City: A Qualitative Analysis

Type: Journal Article

Authors: W. Martinez, J. Galvan, N. Saavedra, S. Berenzon

Year: 2017

Publication Place: United States

Abstract: OBJECTIVE: Despite the high prevalence of mental disorders in Mexico, minimal mental health services are available and there are large gaps in mental health treatment. Community-based primary care settings are often the first contact between patients and the health system and thus could serve as important settings for assessing and treating mental disorders. However, no formal assessment has been undertaken regarding the feasibility of implementing these services in Mexico. Before tools are developed to undertake such an assessment, a more nuanced understanding of the microprocesses affecting mental health service delivery must be acquired. METHODS: A qualitative study used semistructured interviews to gather information from 25 staff in 19 community-based primary care clinics in Mexico City. Semistructured interviews were analyzed by using the meaning categorization method. In a second phase of coding, emerging themes were compared with an established typology of barriers to health care access. RESULTS: Primary care staff reported a number of significant barriers to implementing mental health services in primary care clinics, an already fragile and underfunded system. Barriers included the following broad thematic categories: service issues, language and cultural issues, care recipient characteristics, and issues with lack of knowledge. CONCLUSIONS: Results indicate that the implementation of mental health services in primary care clinics in Mexico will be difficult. However, the information in this study can help inform the integration of mental health into community-based primary care in Mexico through the development of adequate evaluative tools to assess the feasibility and progress of integrating these services.

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1708

Barriers to integration of behavioral and social sciences in the general medicine curriculum and recommended strategies to overcome them: A systematic review

Type: Journal Article

Authors: Z. Tabatabaei, S. Yazdani, R. Sadeghi

Year: 2016

Publication Place: Iran

Abstract: INTRODUCTION: The integration of behavioral and social sciences (BSS) into the curriculum of medical students in order to equip them with the necessary knowledge, skills and attitudes is an essential issue, emphasized in many researches. Our aim is to investigate the barriers to integrate BSS into the general medicine curriculum as well as the recommended strategies to overcome such barriers through a systematic review of literature. METHODS: PubMed, ERIC, Scopus, CINAHL, Google Scholar, and OPENGREY were searched for studies on the barriers to integration of BSS into the general medicine curriculum as well as the strategies employed to overcome them until August 28, 2015. RESULTS: Sixteen relevant studies were included and the related domains were categorized as barriers and some strategies were recommended to overcome them. In addition, the quality of the included studies was assessed. CONCLUSION: Despite the prominent role of BSS in the effectiveness of health care, these sciences have not been included in the curriculum of medical students effectively. The identified barriers and the strategies used to overcome them should be considered for all integration programs. Future studies should focus on the process of BSS integration in the medical curricula and should evaluate the efficacy of this integration in more detail.

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1709

Barriers to Medical Provider Support for Prescription Naloxone As Overdose Antidote for Lay Responders

Type: Journal Article

Authors: Traci C. Green, Sarah E. Bowman, Nickolas D. Zaller, Madeline Ray, Patricia Case, Robert Heimer

Year: 2013

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1710

Barriers to Medications for Addiction Treatment: How Stigma Kills

Type: Journal Article

Authors: Sarah E. Wakeman, Josiah D. Rich

Year: 2018

Publication Place: England

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1711

Barriers to mental health care for urban, lower income families referred from pediatric primary care

Type: Journal Article

Authors: J. Larson, S. dosReis, M. Stewart, R. Kushner, E. Frosch, B. Solomon

Year: 2013

Publication Place: United States

Abstract: The aim of this study was to evaluate the association of parent-reported barriers on the likelihood of attending a mental health evaluation after referral from pediatric primary care. As the part of procedure, parents of children (N = 55) referred for mental health from primary care completed a 23-item questionnaire (three subscales; Cronbach alpha > 0.7): intangible barriers, tangible barriers, and child functioning. Logistic regression examined associations between responses and referral follow-through. The results showed that the high levels of intangible barriers were associated with decreased odds of attending the mental health evaluation (OR = 0.20, 0.06-0.83; P = 0.03). Therefore, we conclude that parental concerns about mental health care may be important for engagement in treatment.

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1712

Barriers to naloxone use and acceptance among opioid users, first responders, and emergency department providers in New Hampshire, USA

Type: Journal Article

Authors: Sarah Bessen, Stephen A. Metcalf, Elizabeth C. Saunders, Sarah K. Moore, Andrea Meier, Bethany McLeman, Olivia Walsh, Lisa A. Marsch

Year: 2019

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1713

Barriers to opioid substitution treatment access, entry and retention: A survey of opioid users, patients in treatment, and treating and non-treating physicians

Type: Journal Article

Authors: H. Stover

Year: 2011

Publication Place: Switzerland

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1714

Barriers to opioid use disorder treatment among people who use drugs in the rural United States: A qualitative, multi-site study

Type: Journal Article

Authors: T. J. Stopka, A. T. Estadt, G. Leichtling, J. C. Schleicher, L. S. Mixson, J. Bresett, E. Romo, P. Dowd, S. M. Walters, A. M. Young, W. Zule, P. D. Friedmann, V. F. Go, R. Baker, R. J. Fredericksen

Year: 2024

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1715

Barriers to Participation in a Telemedicine-based, Family-based Behavioral Group Treatment Program for Pediatric Obesity: Qualitative findings from Rural Caregivers

Type: Journal Article

Authors: G. Hoft, B. Forseth, A. Trofimoff, M. Bangash, A. M. Davis

Year: 2024

Abstract:

This study examined factors influencing rural caregivers' decision to decline participation in a healthy lifestyle intervention. Eligible caregivers of rural children who declined participation in a healthy lifestyle intervention were interviewed regarding reasons for declining. Inductive thematic analyses were conducted for responses. Caregiver interviews (n=16) resulted in 5 saturated themes: (1) rural families' household schedules prohibit participation, (2) preference for diverse treatment approaches, (3) desire for information across multimedia platforms, and more communication with a point-of-contact, (4) support for an inclusive approach integrated with existing school practices, and (5) caregivers had an understanding of behaviors that promote health.

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1716

Barriers to physical and mental condition integrated service delivery

Type: Journal Article

Authors: R. G. Kathol, M. Butler, D. D. McAlpine, R. L. Kane

Year: 2010

Publication Place: United States

Abstract: OBJECTIVE: To assess pragmatic challenges faced when implementing, delivering, and sustaining models of integrated mental health intervention in primary care settings. Thirty percent of primary care patients with chronic medical conditions and up to 80% of those with health complexity have mental health comorbidity, yet primary care clinics rarely include onsite mental health professionals and only one in eight patients receive evidence-based mental health treatment. Integrating specialty mental health into primary care improves outcomes for patients with common disorders, such as depression. METHODS: We used key informant interviews documenting barriers to implementation and components that inhibited or enhanced operational success at 11 nationally established integrated physical and mental condition primary care programs. RESULTS: All but one key informant indicated that the greatest barrier to the creation and sustainability of integrated mental condition care in primary care settings was financial challenges introduced by segregated physical and mental health reimbursement practices. For integrated physical and mental health program initiation and outcome changing care to be successful, key components included a clinical and administrative champion-led culture shift, which valued an outcome orientation; cross-disciplinary training and accountability; use of care managers; consolidated clinical record systems; a multidisease, total population focus; and active, respectful coordination of colocated interdisciplinary clinical services. CONCLUSIONS: Correction of disparate physical and mental health reimbursement practices is an important activity in the development of sustainable integrated physical and mental condition care in primary care settings, such as a medical home. Multiple clinical, administrative, and economic factors contribute to operational success.

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1717

Barriers to Post-Acute Care for Patients on Opioid Agonist Therapy; An Example of Systematic Stigmatization of Addiction

Type: Journal Article

Authors: S. E. Wakeman, J. D. Rich

Year: 2016

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1718

Barriers to Primary Care Physicians Prescribing Buprenorphine

Type: Journal Article

Authors: E. Hutchinson, M. Catlin, C. H. A. Andrilla, L-M. Baldwin, R. A. Rosenblatt

Year: 2014

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1719

Barriers to primary medical care among patients at a community mental health center

Type: Journal Article

Authors: Levinson Miller, B. G. Druss, E. A. Dombrowski, R. A. Rosenheck

Year: 2003

Publication Place: United States

Abstract: People with chronic mental disorders may be at risk of reduced access to medical treatment and poor quality of medical care. The authors examined receipt of and barriers to medical treatment among patients at a community mental health center. Fifty-nine patients completed a validated instrument for measuring access to medical care and the quality of primary care. Their responses indicated problems with access to care, and their scores were significantly lower than those of the general population on all four domains used to assess the quality of primary medical care. The findings suggest the need for community mental health centers to better assess and address barriers to primary medical care.

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1720

Barriers to Serving Clients With Co-occurring Disorders in a Transformed Mental Health System

Type: Journal Article

Authors: H. Padwa, E. G. Guerrero, J. T. Braslow, K. M. Fenwick

Year: 2015

Abstract: Objective: The publication of the President's New Freedom Commission Report in 2003 led to hope and anticipation that system transformation would address barriers that have impeded the delivery of integrated services for clients with co-occurring mental health and substance use disorders. Have problems been resolved? This study analyzed providers' perspectives on serving clients with co-occurring disorders in a large mental health system that has undergone transformation. Methods: Six focus groups were conducted with providers at specialty mental health treatment organizations that received funding to transform services. Using content analysis, the authors identified major themes of the focus group discussions. Results: Participants reported several barriers within the mental health system and challenges associated with collaborating with specialty substance abuse treatment providers that impede the delivery of integrated care. Conclusions: In spite of efforts to improve co-occurring disorder service delivery in a transformed mental health system, barriers that have historically impeded integrated treatment persist.

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