Literature Collection

1921

Challenges and opportunities during the COVID-19 pandemic: Treating patients for substance use disorders during the perinatal period

Type: Journal Article

Authors: H. E. Jones, E. Hairston, A. C. Lensch, L. K. Marcus, S. H. Heil

Year: 2021

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1922

Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries

Type: Journal Article

Authors: C. Hanlon, N. P. Luitel, T. Kathree, V. Murhar, S. Shrivasta, G. Medhin, J. Ssebunnya, A. Fekadu, R. Shidhaye, I. Petersen, M. Jordans, F. Kigozi, G. Thornicroft, V. Patel, M. Tomlinson, C. Lund, E. Breuer, M. De Silva, M. Prince

Year: 2014

Publication Place: United States

Abstract: BACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.

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1923

Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act

Type: Journal Article

Authors: Udi E. Ghitza, Betty Tai

Year: 2014

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1924

Challenges and Opportunities for the Use of Medications to Treat Opioid Addiction in the United States and Other Nations of the World

Type: Journal Article

Authors: M. W. Parrino, A. G. Maremmani, P. N. Samuels, I. Maremmani

Year: 2015

Publication Place: England

Abstract: There has been a well documented increase in the use and abuse of prescription opioids and heroin in the United States and other parts of the world. There has also been an increasing focus to increase access to the use of medications (methadone, buprenorphine, Naltrexone/Vivitrol) for opioid addicted individuals under legal supervision. As policymakers engage in strategic initiatives to better prevent and effectively treat chronic opioid addiction, both in the United States and other countries, there are a number of unintended consequences, complicating how best to increase access to effective treatment.

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1925

Challenges and opportunities in strengthening primary mental healthcare for older people in India: a qualitative stakeholder analysis

Type: Journal Article

Authors: T. Kafczyk, K. Hämel

Year: 2024

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1926

Challenges and solutions to integrating mental and physical health care

Type: Journal Article

Authors: B. G. Druss, J. W. Newcomer

Year: 2007

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1927

Challenges applying alcohol brief intervention in diverse practice settings: Populations, outcomes, and costs

Type: Journal Article

Authors: R. Saitz, D. Svikis, G. D'Onofrio, K. L. Kraemer, H. Perl

Year: 2006

Publication Place: United States

Abstract: This article summarizes the proceedings of a symposium at the 2005 Research Society on Alcoholism, Santa Barbara, California. The purpose of the symposium was to address challenges that arise in translating evidence for efficacy of alcohol brief intervention (BI) into diverse clinical settings and populations by reviewing the literature and describing 4 research studies. Dr. Saitz reviewed the limitations in evidence for efficacy of BIs and then described results of a randomized clinical trial of brief motivational intervention for medical inpatients drinking risky amounts. Dr. Svikis presented alternative methods for identifying pregnant women in prenatal care at risk for alcohol and drug problems (including nicotine and caffeine) and BIs to reduce or eliminate use. Dr. D'Onofrio discussed results of a randomized trial of the brief negotiated interview in emergency department patients. Dr. Kraemer presented results of a decision analytic and computer-simulation model regarding the cost-effectiveness of alcohol screening and intervention in primary care settings. Finally, Dr. Perl discussed the salient issues and suggested future directions for work in the area of alcohol BI.

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1928

Challenges in implementing models of coordinated care

Type: Journal Article

Authors: Nicole K. Janich, Michael S. Shafer

Year: 2020

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1929

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

Type: Journal Article

Authors: J. L. Zuchowski, D. E. Rose, A. B. Hamilton, S. E. Stockdale, L. S. Meredith, E. M. Yano, L. V. Rubenstein, K. M. Cordasco

Year: 2014

Abstract: BACKGROUND: Poor communication between primary care providers (PCPs) and specialists is a significant problem and a detriment to effective care coordination. Inconsistency in the quality of primary-specialty communication persists even in environments with integrated delivery systems and electronic medical records (EMRs), such as the Veterans Health Administration (VHA). OBJECTIVE: The purpose of this study was to measure ease of communication and to characterize communication challenges perceived by PCPs and primary care personnel in the VHA, with a particular focus on challenges associated with referral communication. DESIGN: The study utilized a convergent mixed-methods design: online cross-sectional survey measuring PCP-reported ease of communication with specialists, and semi-structured interviews characterizing primary-specialty communication challenges. PARTICIPANTS: 191 VHA PCPs from one regional network were surveyed (54 % response rate), and 41 VHA PCPs and primary care staff were interviewed. MAIN MEASURES/APPROACH: PCP-reported ease of communication mean score (survey) and recurring themes in participant descriptions of primary-specialty referral communication (interviews) were analyzed. KEY RESULTS: Among PCPs, ease-of-communication ratings were highest for women's health and mental health (mean score of 2.3 on a scale of 1-3 in both), and lowest for cardiothoracic surgery and neurology (mean scores of 1.3 and 1.6, respectively). Primary care personnel experienced challenges communicating with specialists via the EMR system, including difficulty in communicating special requests for appointments within a certain time frame and frequent rejection of referral requests due to rigid informational requirements. When faced with these challenges, PCPs reported using strategies such as telephone and e-mail contact with specialists with whom they had established relationships, as well as the use of an EMR-based referral innovation called "eConsults" as an alternative to a traditional referral. CONCLUSIONS: Primary-specialty communication is a continuing challenge that varies by specialty and may be associated with the likelihood of an established connection already in place between specialty and primary care. Improvement in EMR systems is needed, with more flexibility for the communication of special requests. Building relationships between PCPs and specialists may also facilitate referral communication.

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1930

Challenges in Treatment of Comorbid Chronic Pain, Depression, and Anxiety

Type: Journal Article

Authors: Marsha Snyder, Cynthia Taylor Handrup

Year: 2018

Publication Place: Thorofare, New Jersey

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1931

Challenges of addressing opioid use disorder in rural settings: A state perspective

Type: Journal Article

Authors: L. M. Letourneau

Year: 2021

Publication Place: United States

Abstract:

Rural states and communities continue to face significant challenges as they work to address the ongoing opioid epidemic and to implement specific strategies for prevention and treatment of opioid use disorder (OUD) and other substance use disorders (SUDs). While a growing number of innovative strategies have been identified that can offer promise for rural communities, state and clinical leaders from rural communities will need to identify evidence-based approaches that can work best in their communities, and ways to tailor options to meet their unique needs. This article identifies a set of five considerations for rural states and communities as they continue their work to identify solutions to this deadly epidemic.

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1932

Challenges of adopting the role of care manager when implementing the collaborative care model for people with common mental illnesses: A scoping review

Type: Journal Article

Authors: Ariane Girard, Édith Ellefsen, Pasquale Roberge, Jean‐Daniel Carrier, Catherine Hudon

Year: 2019

Publication Place: Malden, Massachusetts

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1933

Challenges on the road to recovery: Exploring attitudes and experiences of clients in a community-based buprenorphine program in Baltimore City

Type: Journal Article

Authors: C. Truong, N. Krawczyk, M. Dejman, S. Marshall-Shah, K. Tormohlen, D. Agus, J. Bass

Year: 2019

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1934

Challenges to alcohol and other drug discussions in the general practice consultation

Type: Journal Article

Authors: Helen J. Moriarty, Maria H. Stubbe, Laura Chen, Rachel M. Tester, Lindsay M. Macdonald, Anthony C. Dowell, Kevin P. Dew

Year: 2012

Publication Place: United Kingdom

Abstract: Background. There is a widely held expectation that GPs will routinely use opportunities to provide opportunistic screening and brief intervention for alcohol and other drug (AOD) abuse, a major cause of preventable death and morbidity. Aim. To explore how opportunities arise for AOD discussion in GP consultations and how that advice is delivered. Design. Analysis of video-recorded primary care consultations Setting. New Zealand General Practice. Methods. Interactional content analysis of AOD consultations between 15 GP's and 56 patients identified by keyword search from a bank of digital video consultation recordings. Results. AOD-related words were found in almost one-third (56/171) of the GP consultation transcripts (22 female and 34 male patients). The AOD dialogue varied from brief mention to pertinent advice. Tobacco and alcohol discussion featured more often than misuse of anxiolytics, night sedation, analgesics and caffeine, with only one direct enquiry about other (unspecified) recreational drug use. Discussion was associated with interactional delicacy on the part of both doctor and patient, manifested by verbal and non-verbal discomfort, use of closed statements, understatement, wry humour and sudden topic change. Conclusions. Mindful prioritization of competing demands, time pressures, topic delicacy and the acuteness of the presenting complaint can impede use of AOD discussion opportunities. Guidelines and tools for routine screening and brief intervention in primary care do not accommodate this reality. Possible responses to enhance AOD conversations within general practice settings are discussed. Adapted from the source document.

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1935

Change in Drug Use Disorders Identification Test – Consumption (DUDIT-C) with telehealth treatment compared to in-person treatment

Type: Journal Article

Authors: Jonathan Neufeld, Fred Ullrich, Kimberly A. S. Merchant, Divya Bhagianadh, Knute D. Carter, James P. Marcin, Eve-Lynn Nelson, Carly McCord, Kari Beth Law, Marcia M. Ward

Year: 2023

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1936

Change in opioid and buprenorphine prescribers and prescriptions by specialty, 2016–2021

Type: Journal Article

Authors: Marc R. Larochelle, Christopher M. Jones, Kun Zhang

Year: 2023

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1937

Changes and predictors of change in the physical health status of heroin users over 24 months

Type: Journal Article

Authors: A. Williamson, S. Darke, J. Ross, M. Teesson

Year: 2009

Publication Place: England

Abstract: AIMS: (i) To describe the course of physical health among the ATOS cohort over 24 months; and (ii) to examine the effects of treatment, drug use patterns and social and psychological factors on health status over 24 months. DESIGN: Longitudinal cohort. SETTING: Sydney, Australia. PARTICIPANTS: A total of 615 heroin users recruited for the Australian Treatment Outcome Study (ATOS). FINDINGS: The general health of the cohort improved significantly over 24 months. Significant predictors of poor health over 24 months were: being older, being female, past month heroin, other opiate and tobacco use, past month unemployment and current major depression. Spending a greater proportion of time in residential rehabilitation (RR) was associated with better health over 24 months. No other treatment factors demonstrated a significant, independent relationship with health. CONCLUSIONS: The physical health of dependent heroin users is affected by drug use and psychosocial problems. RR treatment appears to be particularly beneficial to the health of heroin users, suggesting the importance of a comprehensive approach to improving health among this group.

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1938

Changes in buprenorphine visits in frontier and remote locations: Effects of the SARS-CoV-2 pandemic

Type: Journal Article

Authors: L. M. McFadden

Year: 2023

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1939

Changes in buprenorphine waivered provider supply after Virginia Medicaid implements the addiction and recovery treatment services program and Medicaid expansion

Type: Journal Article

Authors: A. F. Urmi, E. Britton, H. Saunders, A. Harrell, C. Bachireddy, J. Lowe, A. J. Barnes, P. Cunningham

Year: 2024

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1940

Changes In County-Level Access To Medications For Opioid Use Disorder After Medicare Coverage Of Methadone Treatment Began

Type: Journal Article

Authors: S. J. Harris, C. R. Yarbrough, A. J. Abraham

Year: 2023

Abstract:

In 2020 Medicare began reimbursing for opioid treatment program (OTP) services, including methadone maintenance treatment for opioid use disorder (OUD), for the first time. Methadone is highly effective for OUD, yet its availability is restricted to OTPs. We used 2021 data from the National Directory of Drug and Alcohol Abuse Treatment Facilities to examine county-level factors associated with OTPs accepting Medicare. In 2021, 16.3 percent of counties had at least one OTP that accepted Medicare. In 124 counties the OTP was the only specialty treatment facility offering any form of medication for opioid use disorder (MOUD). Regression results showed that the odds of a county having an OTP that accepted Medicare were lower for counties with higher versus lower percentages of rural residents and lower for counties located in the Midwest, South, and West compared with the Northeast. The new OTP benefit improved the availability of MOUD treatment for beneficiaries, although geographic gaps in access remain.

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