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Troberg K, Lundqvist K, Hansson H, Håkansson A, Dahlman D. Healthcare seeking among Swedish patients in opioid substitution treatment – a mixed methods study on barriers and facilitators. Subst Abuse Treat Prev Policy 2022; 17:8. [PMID: 35123518 PMCID: PMC8817477 DOI: 10.1186/s13011-022-00434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patients in opioid substitution treatment (OST) have poorer health than the general population. Thus, they do not seek somatic health care to the extent that is medically motivated. Barriers hindering patients from seeking medical help through the conventional healthcare system result in a high degree of unmet healthcare needs. Barriers to, and facilitators of, OST patients’ healthcare seeking have been sparsely examined. Methods Mixed methods were employed. The quantitative part consisted of a cross-sectional questionnaire covering questions on physical health, healthcare seeking, and barriers thereof, which was collected from 209 patients in OST. A sub-sample of eleven OST patients participated in semi-structured interviews, for the qualitative part of the study, covering experience of healthcare, lifestyle, and self-images, expectations, and ideals of Swedish healthcare. Results Confirmed by qualitative data, quantitative data revealed deprioritization, fear of stigma and of being treated badly, and problems in navigation throughout the healthcare system, leading to unsuccessful establishment of contact, being most common reasons for not seeking somatic healthcare. Thus, interviewees provided a deeper knowledge of the barriers stigma, lack of means to prioritize health and difficulties navigating throughout the healthcare system, leading to resignation and deprioritization. On-site primary healthcare (PHC) seemed to contribute to increased access and utilization of healthcare. Conclusion Individual and structural barriers decreasing access to healthcare lead to increased inequalities in healthcare utilization, adding to an already deteriorating health of this ageing population. Integration of on-site primary healthcare and OST could provide acceptable and accessible healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00434-w.
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Vikbladh T, Troberg K, Håkansson A, Dahlman D. Healthcare utilization for somatic conditions among Swedish patients in opioid substitution treatment, with and without on-site primary healthcare. BMC Health Serv Res 2022; 22:971. [PMID: 35906595 PMCID: PMC9338550 DOI: 10.1186/s12913-022-08351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Opioid substitution treatment (OST) populations are aging and have increased mortality and somatic morbidity compared to general populations internationally. While OST patients have poor self-rated physical health and unmet healthcare needs, documented healthcare utilization has been sparsely investigated. The aim of this study was to assess registered healthcare utilization for somatic conditions in a sample of Swedish OST patients, and compare healthcare utilization among OST patients with and without use of on-site primary healthcare (PHC). Methods Patients in OST in Malmö, Sweden, were recruited for a survey study conducted in 2017–2018. Survey data were compared with comprehensive patient records from specialized and primary care during one year prior to study inclusion (total n = 190). All patient records were examined for healthcare utilization, source of healthcare (PHC, emergency care and secondary care), and documented diagnoses and symptoms. Factors associated with healthcare utilization were analyzed by using logistic regression analysis. Patients with and without on-site PHC were compared by using descriptive statistics and Chi-2 test. Results A total of 88% of the sample had been in direct or indirect contact with somatic healthcare during one year (PHC 66%; emergency care 28%; secondary care 67%). The most prevalent somatic diagnoses were infectious diseases (39%) and symptom diagnoses (37%). Respiratory, dermatological and musculoskeletal diagnoses, and trauma/intoxication were documented in 21–26% of the sample, respectively. PHC utilization was associated with older age and being born in Sweden. Among patients with on-site PHC (n = 25), the number utilizing secondary care was 84%, and certain diagnostic codes were more frequent in this group. Conclusion OST patients are seemingly underserved as regards their physical health. Since increased OST access decreases opioid overdose fatalities, the life expectancy among OST patients is likely to increase and thereby also increases the risk of age-related conditions. Thus, easily accessible physical healthcare is of great importance in this group. On-site PHC might be a way to establish healthcare contact with OST patients, especially for non-acute conditions, although further research is needed.
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Affiliation(s)
- Teodor Vikbladh
- Center for Primary Health Care Research, Department of Clinical Sciences, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503, 22, Malmö, Sweden
| | - Katja Troberg
- Malmö Addiction Centre, Skåne University Hospital, Malmö, Sweden.,Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anders Håkansson
- Malmö Addiction Centre, Skåne University Hospital, Malmö, Sweden.,Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503, 22, Malmö, Sweden. .,Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
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3
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Fleury MJ, Grenier G, Cao Z, Huỳnh C. Predictors of no, low and frequent emergency department use for any medical reason among patients with cannabis-related disorders attending Quebec (Canada) addiction treatment centres. Drug Alcohol Rev 2022; 41:1136-1151. [PMID: 35266240 DOI: 10.1111/dar.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with substance-related disorders and mental disorders (MD) contribute substantially to emergency department (ED) overcrowding. Few studies have identified predictors of ED use integrating service use correlates, particularly among patients with cannabis-related disorders (CRD). This study compared predictors of low (1-2 visits/year) or frequent (3+ visits/year) ED use with no ED use for a cohort of 9836 patients with CRD registered at Quebec (Canada) addiction treatment centres in 2012-2013. METHODS This longitudinal study used multinomial logistic regression to evaluate clinical, sociodemographic and service use variables from various databases as predictors of the frequency of ED use for any medical reason in 2015-2016 among patients with CRD. RESULTS Compared to non-ED users with CRD, frequent ED users included more women, rural residents, patients with serious MD and chronic CRD, dropouts from programs in addiction treatment centres and with less continuity of physician care. Compared with non-users, low ED users had more common MD and there more workers than students. DISCUSSION AND CONCLUSIONS Multimorbidity, including MD, chronic physical illnesses and other substance-related disorders than CRD, predicted more ED use and explained frequent use of outpatient services and prior specialised acute care, as did being 12-29 years, after controlling for all other covariates. Better continuity of physician care and reinforcement of programs like assertive community or integrated treatment, and chronic primary care models may protect against frequent ED use. Strategies like screening, brief intervention and treatment referral, including motivational therapy for preventing treatment dropout may also be expanded to decrease ED use.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Christophe Huỳnh
- Institut Universitaire sur les Dépendances, Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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O’Grady MA, Randrianarivony R, Martin K, Perez-Cubillan Y, Collymore DC, Shapiro-Luft D, Beacham A, Heyward N, Greenfield B, Neighbors CJ. Together in care: Lessons learned at the intersection of integrated care, quality improvement, and implementation practice in opioid treatment programs. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221135265. [PMID: 37091088 PMCID: PMC9924288 DOI: 10.1177/26334895221135265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Integrated care programs that systematically and comprehensively address both behavioral and physical health may improve patient outcomes. However, there are few examples of such programs in addiction treatment settings. This article is a practical implementation report describing the implementation of an integrated care program into two opioid treatment programs (OTPs). Method Strategies used to implement integrated care into two OTPs included external facilitation, quality improvement (QI) processes, staff training, and an integrated organizational structure. Service, implementation, and client outcomes were examined using qualitative interviews with program staff (n = 16), program enrollment data, and client outcome data (n = 593) on mental health (MH), physical health, and functional indicators. Results Staff found the program to generally be acceptable and appropriate, but also noted that the new services added to already busy workflows and more staffing were needed to fully reach the program's potential. The program had a high level of penetration (∼60%–70%), enrolling over 1,200 clients. Staff noted difficulties in connecting clients with some services. Client general functioning and MH symptoms improved, and heavy smoking decreased. The organizational structure and QI activities provided a strong foundation for interactive problem-solving and adaptations that were needed during implementation. Conclusions This article highlights an example of the intersection of QI and implementation practice. Simplified QI processes, consistent post-implementation meetings, and change teams and champions facilitated implementation; however, ongoing training and support, especially related to data are needed. The OTP setting provided a strong foundation to build integrated care, but careful consideration of new workflows and changes in philosophy for staff is necessary. Plain Language Summary: Providing medical and behavioral health treatment services in the same clinic using coordinated treatment teams, also known as integrated care, improves outcomes among those with chronic physical and behavioral health conditions. However, there are few practical examples of implementation of such programs in addiction treatment settings, which are promising, yet underutilized settings for integrated care programs. A multi-sectoral team used quality improvement (QI) and implementation strategies to implement integrated care into two opioid treatment programs (OTPs). The program enrolled over 1,200 clients and client general functioning and mental health (MH) symptoms improved, and heavy smoking decreased. Qualitative interviews provided important information about the barriers, facilitators, and context around implementation of this program. The OTP setting provided a strong foundation to build integrated care, but careful consideration of new workflows and changes in philosophy for staff, as well as ongoing training and supports for staff, are necessary. This project may help to advance the implementation of integrated care in OTPs by identifying barriers and facilitators to implementation, lessons learned, as well as providing a practical example of potentially useful QI and implementation strategies.
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Affiliation(s)
- Megan A. O’Grady
- Departmet of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | | | | | | | | | | | - Nyasia Heyward
- Bureau of Adult Treatment, New York State Office of Addiction Services and Supports, New York, USA
| | - Belinda Greenfield
- Bureau of Adult Treatment, New York State Office of Addiction Services and Supports, New York, USA
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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O'Grady MA, Neighbors CJ, Randrianarivony R, Shapiro-Luft D, Tempchin J, Perez-Cubillan Y, Collymore DC, Martin K, Heyward N, Wu M, Beacham A, Greenfield B. Identifying the Physical and Mental Healthcare Needs of Opioid Treatment Program Clients. Subst Use Misuse 2022; 57:1164-1169. [PMID: 35440294 DOI: 10.1080/10826084.2022.2064508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Individuals with opioid use disorder (OUD) often have significant medical and behavioral health needs that are unaddressed. Opioid treatment programs (OTP) are uniquely positioned to provide integrated services for OUD, physical and mental health but are underutilized for this purpose. This study aims to describe the physical and mental healthcare needs of OTP clients in order to inform integrated care implementation in OTPs. Method: OTP clients (n = 1261) in an integrated care program in the Bronx borough of New York City were assessed for mental health symptoms (e.g., anxiety, depression), chronic disease indicators (e.g., blood pressure, cholesterol), and general functioning (e.g., capability of managing healthcare needs). Results: Symptoms of anxiety, post-traumatic stress, and depression were common. Self-reported health status and level of functioning were generally poor. Heavy smoking and obesity were the most frequent physical health risks. Other chronic disease indicators (e.g., blood pressure) showed 25-46% may be at risk. Sixty percent had multiple mental health risks and 85% had multiple physical health risks. Older clients had a higher rate of hypertension and diabetes risk than younger clients. Conclusions: Integrated care programs in OTPs must be prepared to address and coordinate care for chronic mental and physical health conditions in addition to OUD.
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Affiliation(s)
- Megan A O'Grady
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Charles J Neighbors
- New York University Grossman School of Medicine, New York City, New York, USA
| | | | | | - Jacob Tempchin
- Partnership to End Addiction, New York City, New York, USA
| | | | | | | | - Nyasia Heyward
- New York State Office of Addiction Services and Supports, Albany, New York, USA
| | - Morgan Wu
- Partnership to End Addiction, New York City, New York, USA
| | - Alexa Beacham
- Partnership to End Addiction, New York City, New York, USA
| | - Belinda Greenfield
- New York State Office of Addiction Services and Supports, Albany, New York, USA
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Heinze G, Sartorius N, Guizar Sanchez DP, Bernard-Fuentes N, Cawthorpe D, Cimino L, Cohen D, Lecic-Tosevski D, Filipcic I, Lloyd C, Mohan I, Ndetei D, Poyurovsky M, Rabbani G, Starostina E, Yifeng W, EstefaníaLimon L. Integration of mental health comorbidity in medical specialty programs in 20 countries. Int J Psychiatry Med 2021; 56:278-293. [PMID: 33827304 DOI: 10.1177/00912174211007675] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
METHODS A systematic analysis was performed of the medical specialization academic programs of 20 different countries to establish which medical specialties take into account mental health issues in the specialty curricular design and which mental health content these programs address. The criteria that were explored in the educational programs include: 1) name of the medical specialties that take into account mental health content in curriculum design, 2) name of the mental health issues addressed by these programs. After independent review and data extraction, paired investigators compared the findings and reached consensus on all discrepancies before the final presentation of the data. Descriptive statistics evaluated the frequency of the data presented. RESULTS Internal medicine, family medicine, neurology, pediatrics and geriatrics were the specialties that included mental health topics in their programs. In four countries: Bangladesh, Serbia, the Netherlands and France, 50%of all graduate specialty training programs include mental health content. In ten countries: Germany, Sweden, the United Kingdom, Mexico, Belgium, India, Russia, Canada, Israel and Spain, between 20% and 49% of all graduate specialty training programs include mental health content. In six countries - Brazil, Chile, Colombia, Croatia, Kenya, and the United States-less than 20% of all graduate specialty training programs include mental health content. DISCUSSION The proposal that we have made in this article should be taken into account by decision-makers, in order to complement the different postgraduate training programs with mental health issues that are frequently present with other physical symptoms. It is not our intention that the different specialists know how to treat psychiatric comorbidities, but rather pay attention to their existence and implications in the diagnosis, evolution and prognosis of many other diseases. The current fragmentation of medicine into ever finer specialties makes the management of comorbidity ever more difficult: a reorientation of post- graduate training might improve the situation.
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Affiliation(s)
- Gerhard Heinze
- Departamento de Fisiología National Autonomous University of Mexico (UNAM) School of Medicine, Mexico City, Mexico
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | | | - Napoleón Bernard-Fuentes
- Departamento de Fisiología National Autonomous University of Mexico (UNAM) School of Medicine, Mexico City, Mexico
| | - David Cawthorpe
- Department of Psychiatry & Community Health Sciences, Cumming School of Medicine, Institute for Child & Maternal Health, The University of Calgary, Calgary, Canada
| | - Larry Cimino
- Dialogue on Diabetes and Depression, ProConsult, LLC, Las Vegas, USA
| | - Dan Cohen
- Heerhugowaard, Mental Health Organization, Amsterdam, the Netherlands
| | - Dusica Lecic-Tosevski
- Serbian Academy of Sciences and Arts, Institute of Mental Health, Scholl of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Filipcic
- Faculty of Dental Medicine and Health, Department of Psychiatry, University of Osijek, Osijek, Croatia
| | - Cathy Lloyd
- Faculty of Wellbeing, Education and Language Studies, School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Isaac Mohan
- Community, Culture and Mental Health Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Australia
| | - David Ndetei
- University of Nairobi, Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Michael Poyurovsky
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Ma'ale HaCarmel Mental Health Center, Tirat Carmel, Israel
| | - Golam Rabbani
- Ma'ale HaCarmel Mental Health Center, Tirat Carmel, Israel
| | - Elena Starostina
- Neurodevelopmental Disability Protection Trustee Board of Bangladesh, Dhaka, Bangladesh
| | - Wei Yifeng
- Department of Endocrinology, Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - Limón EstefaníaLimon
- Departamento de Fisiología National Autonomous University of Mexico (UNAM) School of Medicine, Mexico City, Mexico
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Huang CL, Tsai IJ, Lin WC, Ho IK, Wang RY, Lee CWS. Augmentation in Healthcare Utilization of Patients with Opioid Use Disorder After Methadone Maintenance Treatment: A Retrospective Nationwide Study. Adv Ther 2021; 38:2908-2919. [PMID: 33559050 DOI: 10.1007/s12325-021-01633-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The health benefits of entering methadone maintenance treatment (MMT) for opioid-dependent persons may not be merely limited to therapy of opioid use disorder. We aimed to compare the healthcare utilization of MMT patients before and after MMT. METHODS A retrospective analysis was performed using the Taiwan Illicit Drug Issue Database and the National Health Insurance Research Database (NHIRD) between 2014 and 2016. We included 1255 newly enrolled MMT patients in 2015 and randomly selected 5020 patients from NHIRD matched by age and gender as the comparison group. Changes in healthcare utilization 1 year before and 1 year after the date of the index date (MMT initiation) were compared within and between MMT and comparison groups. RESULTS During the 1-year period following MMT, the hospitalization length was considerably decreased, while the number of outpatient visits, emergency department (ED) visits, and ED expenditure significantly increased in MMT patients. Multivariable linear regression with the difference-in-difference approach revealed that all the categories of healthcare utilization increased, except for a minor increase of outpatient expenditure and a slight decrease of hospitalization length for the MMT group relative to the comparison group. Increases in utilization of the departments of psychiatry and infectious diseases of the MMT patients were considerable. CONCLUSION MMT is associated with increased healthcare utilization, and departments of psychiatry and infectious diseases play substantial roles. Policy-makers should warrant access for all who need healthcare by ensuring the availability of the treatment for drug dependence.
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Affiliation(s)
- Chieh-Liang Huang
- School of Medicine, China Medical University, Taichung, Taiwan
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - I-Ju Tsai
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Chi Lin
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ing-Kang Ho
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Ruey-Yun Wang
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Cynthia Wei-Sheng Lee
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan.
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.
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8
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Lewer D, Freer J, King E, Larney S, Degenhardt L, Tweed EJ, Hope VD, Harris M, Millar T, Hayward A, Ciccarone D, Morley KI. Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis. Addiction 2020; 115:1011-1023. [PMID: 31705770 PMCID: PMC7210080 DOI: 10.1111/add.14892] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/04/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022]
Abstract
AIMS To summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs. DESIGN Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health-care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525). SETTING AND PARTICIPANTS People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4-methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services. MEASUREMENTS Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED). FINDINGS Ninety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114-201] and 41 (95% CI = 30-57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances. CONCLUSIONS People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.
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Affiliation(s)
- Dan Lewer
- UCL Collaborative Centre for Inclusion HealthInstitute of Epidemiology and Health Care UCLLondonUK
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Joseph Freer
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
| | - Emma King
- UCL Collaborative Centre for Inclusion HealthInstitute of Epidemiology and Health Care UCLLondonUK
| | - Sarah Larney
- National Drug and Alcohol Research Centre (NDARC)University of New South WalesRandwick,NSWAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC)University of New South WalesRandwick,NSWAustralia
| | - Emily J. Tweed
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Vivian D. Hope
- Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
| | - Magdalena Harris
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical Medicine, LondonUK
| | - Tim Millar
- Centre for Mental Health and SafetyThe University of ManchesterManchesterUK
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion HealthInstitute of Epidemiology and Health Care UCLLondonUK
| | - Dan Ciccarone
- Department of Family and Community MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Katherine I. Morley
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population HealthThe University of MelbourneMelbourneAustralia
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9
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Self-Rated Physical Health and Unmet Healthcare Needs among Swedish Patients in Opioid Substitution Treatment. JOURNAL OF ADDICTION 2019; 2019:7942145. [PMID: 31139491 PMCID: PMC6500657 DOI: 10.1155/2019/7942145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 01/16/2023]
Abstract
Background Individuals with opioid dependence are at increased risk of deteriorating health due to the lifestyle connected to heroin use. Barriers surrounding the healthcare system seem to hinder patients to seek help through conventional healthcare, even after entering opioid substitution treatment (OST), resulting in a high level of unmet healthcare needs. However, this field is still unexplored, with only a few studies focusing on general health within this population. The first step, in order to provide suitable and accessible primary healthcare, is to assess the extent of physical symptoms and unmet healthcare needs within the OST population, which, to this point, has been sparsely studied. Aim To assess OST patients' self-rated physical health and healthcare seeking behaviour. Methods Two-hundred and eighteen patients from four different OST sites answered a questionnaire regarding physical health and healthcare seeking. Results Patients in OST have a high degree of physical symptoms and a high degree of unmet healthcare needs. Sixty-six percent reported suffering from musculoskeletal pain. Fifty-six percent reported gastrointestinal symptoms. Genital problems and airway symptoms were reported by 47%, respectively, and dental problems were reported by 69% of the respondents. General unmet healthcare needs were reported by 82%. Musculoskeletal pain was positively correlated with having an unstable housing situation (AOR 4.26 [95% CI 1.73-10.48]), negatively correlated with male sex (AOR 0.45 [95% CI 0.22-0.91]), and positively correlated with age (AOR 1.04 [95% CI 1.01-1.07]). No statistically significant correlates of respiratory, gastrointestinal, genital, or dental symptoms were found. Conclusion Patients in OST carry a heavy burden of physical symptoms and unmet healthcare needs, potentially due to societal barriers. Patients' frequent visits to the OST clinics offer a unique opportunity to build a base for easily accessible on-site primary healthcare.
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10
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Binswanger IA, Carroll NM, Ahmedani BK, Campbell CI, Haller IV, Hechter RC, McNeely J, Yarborough BJH, Kline-Simon AH, Satre DD, Weisner C, Lapham GT. The association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) measures of treatment initiation and engagement for alcohol and other drug use disorders. Subst Abus 2019; 40:292-301. [PMID: 30676892 DOI: 10.1080/08897077.2018.1545726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Medical comorbidity may influence treatment initiation and engagement for alcohol and other drug (AOD) use disorders. We examined the association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) treatment initiation and engagement measures.Methods: We used electronic health record and insurance claims data from 7 US health care systems to identify patients with AOD use disorders between October 1, 2014, and August 15, 2015 (N = 86,565). Among patients identified with AOD use disorders in outpatient and emergency department (ED) settings, we examined how Charlson/Deyo comorbidity index scores and medical complications of AOD use were associated with treatment initiation. Among those who initiated treatment in inpatient and outpatient/ED settings, we also examined how comorbidity and AOD use-related medical complications were associated with treatment engagement. Analyses were conducted using generalized estimating equation logistic regression modeling.Results: Among patients identified as having an AOD diagnosis in outpatient and ED settings (n = 69,965), Charlson/Deyo comorbidity index scores of 2 or more were independently associated with reduced likelihood of initiation (risk ratio [RR] = 0.80, 95% confidence interval [CI] = 0.74, 0.86; reference score = 0), whereas prior-year diagnoses of cirrhosis (RR = 1.25, 95% CI = 1.12, 1.35) and pancreatic disease (RR = 1.34, 95% CI = 1.15, 1.56) were associated with greater likelihood of initiation. Among those who were identified in outpatient/ED settings and initiated, higher comorbidity scores were associated with lower likelihood of engagement (score 1: RR = 0.85, 95% CI = 0.76, 0.94; score 2+: RR = 0.61, 95% CI = 0.53, 0.71).Conclusion: Medical comorbidity was associated with lower likelihood of initiating or engaging in AOD treatment, but cirrhosis and pancreatic disease were associated with greater likelihood of initiation. Interventions to improve AOD treatment initiation and engagement for patients with comorbidities are needed, such as integrating medical and AOD treatment.
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Affiliation(s)
- Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.,Colorado Permanente Medical Group, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | | | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Irina V Haller
- Essentia Institute of Rural Health, Essentia, Essentia Health, Duluth, Minnesota, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jennifer McNeely
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | | | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
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11
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Han BH, Termine DJ, Moore AA, Sherman SE, Palamar JJ. Medical multimorbidity and drug use among adults in the United States. Prev Med Rep 2018; 12:214-219. [PMID: 30370208 PMCID: PMC6202656 DOI: 10.1016/j.pmedr.2018.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/17/2018] [Accepted: 10/14/2018] [Indexed: 02/07/2023] Open
Abstract
Adults with medical multimorbidity (≥2 chronic conditions) present challenges for health care systems to provide coordinated care. Substance use can complicate the management of chronic medical conditions, but little research has focused on the intersection of medical multimorbidity and substance use. This study uses cross-sectional analysis of 115,335 adult respondents of the 2012-2014 administrations of the National Survey on Drug Use and Health to estimate the prevalence and correlates of past-year drug use among adults with multimorbidity. The prevalence of past-year drug use was compared between individuals reporting 0, 1, and ≥2 chronic medical conditions. We used multivariable logistic regression to determine correlates of past-year drug use among adults with ≥2 chronic medical conditions. 53.1% reported no chronic conditions, 29.5% reported one chronic condition, and 17.4% reported ≥2 chronic conditions. Past-year drug use was reported by 18.3% of those with no chronic conditions, 14.8% with 1 chronic condition, and 11.6% with ≥2 chronic conditions. Cannabis and opioid analgesics (nonmedical use) were the most common drugs used across all three groups. In the adjusted model, among adults with medical multimorbidity, adults with past-year drug use were more likely to be younger, male, have lower income, and report current tobacco use, alcohol dependence, past-year depression, and having received mental health treatment in the past year. In this national cohort, fewer adults with multimorbidity reported substance use compared to adults with no or one chronic condition, however, this population with high multimorbidity may be particularly vulnerable to the negative effects of drug use.
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Affiliation(s)
- Benjamin H. Han
- New York University School of Medicine, Department of Medicine, Division of Geriatric Medicine and Palliative Care, 550 First Avenue, BCD 615, New York, NY 10016, United States of America
- New York University Langone Medical Center, Department of Population Health, 550 First Avenue, New York, NY 10016, United States of America
- Center for Drug Use and HIV/HCV Research, New York University Rory College of Nursing, 433 First Avenue, 7th Floor, New York, NY 10010, United States of America
| | - Domenic J. Termine
- University of Cincinnati, College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America
| | - Alison A. Moore
- University of California, San Diego, Department of Medicine, Division of Geriatrics, 9500 Gilman Drive, La Jolla, CA 92093, United States of America
| | - Scott E. Sherman
- New York University School of Medicine, Department of Medicine, Division of Geriatric Medicine and Palliative Care, 550 First Avenue, BCD 615, New York, NY 10016, United States of America
- New York University Langone Medical Center, Department of Population Health, 550 First Avenue, New York, NY 10016, United States of America
- Center for Drug Use and HIV/HCV Research, New York University Rory College of Nursing, 433 First Avenue, 7th Floor, New York, NY 10010, United States of America
- VA New York Harbor Healthcare System, New York, NY 10010, United States of America
| | - Joseph J. Palamar
- New York University Langone Medical Center, Department of Population Health, 550 First Avenue, New York, NY 10016, United States of America
- Center for Drug Use and HIV/HCV Research, New York University Rory College of Nursing, 433 First Avenue, 7th Floor, New York, NY 10010, United States of America
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12
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Huynh C, Ferland F, Blanchette-Martin N, Ménard JM, Fleury MJ. Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders. Psychiatr Q 2016; 87:713-728. [PMID: 26875101 DOI: 10.1007/s11126-016-9422-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study assessed the characteristics of individuals with substance use disorders (ISUDs) according to their frequency of emergency department (ED) utilization, and examined which variables were associated with an increase in ED visits using Andersen's model. Data linkage of administrative databanks from three sources [addiction rehabilitation centre registry, physician billing systems, and hospital discharge databank] for 4526 ISUDs was performed. Predisposing, enabling and need factors associated with number of ED visits were determined using a negative binomial regression model and generalised estimating equations. The rate of ED utilization for this population was 9.6 %. Increased number of ED visits was associated with the following variables: older age, social fragmentation, number of consultations with general practitioners, number of consultations with psychiatrists, number of consultations with other types of physicians, alcohol abuse, drug abuse, schizophrenia, anxiety disorders, personality disorders, co-occurring substance dependence and mental disorders, co-occurring substance dependence and chronic physical disorders, and co-occurring mental health disorders and chronic physical disorders. By contrast, a diagnosis of substance dependence, co-occurring drug and alcohol abuse, and a co-occurring diagnosis of substance dependence with mental health and chronic physical disorders decreased ED visits. Efforts to reduce avoidable use of EDs should focus on chronic-disease management and other related strategies aimed at reinforcing services to ISUDs in the community, especially for ISUDs with a co-occurring diagnosis of either mental health disorders or chronic physical disorders.
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Affiliation(s)
- Christophe Huynh
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, 950, rue de Louvain Est, Montreal, QC, H2M 2E8, Canada.
| | - Francine Ferland
- Centre de réadaptation en dépendance de Québec, 2525, chemin de la Canardière, Quebec, QC, G1J 2G3, Canada.,Centre de réadaptation en dépendance de Chaudière-Appalaches, 419, Dorimène-Desjardins, Lévis, QC, G6V 5V3, Canada
| | - Nadine Blanchette-Martin
- Centre de réadaptation en dépendance de Québec, 2525, chemin de la Canardière, Quebec, QC, G1J 2G3, Canada.,Centre de réadaptation en dépendance de Chaudière-Appalaches, 419, Dorimène-Desjardins, Lévis, QC, G6V 5V3, Canada
| | - Jean-Marc Ménard
- Centre de réadaptation en dépendance Domrémy-de-la-Mauricie-Centre-du-Québec, 440 rue des Forges, Trois-Rivières, QC, G9A 2H5, Canada
| | - Marie-Josée Fleury
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, 950, rue de Louvain Est, Montreal, QC, H2M 2E8, Canada.,Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Quebec, Canada
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13
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Huỳnh C, Tremblay J, Fleury MJ. Typologies of Individuals Attending an Addiction Rehabilitation Center Based on Diagnosis of Mental Disorders. J Subst Abuse Treat 2016; 71:68-78. [DOI: 10.1016/j.jsat.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 09/08/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
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Abstract
BACKGROUND The economic costs associated with opioid misuse are immense. Effective interventions for opioid use disorders are available; however, given the scarce resources faced by substance use treatment providers and payers of all kinds, evidence of effectiveness is not always sufficient to encourage adoption of a given therapy-nor should it be. Economic evaluations can provide evidence that will help stakeholders efficiently allocate their resources. OBJECTIVE The purpose of this study was to review the literature on economic evaluations of opioid use disorder interventions. METHODS We performed a systematic review of the major electronic databases from inception until August 2015. A sensitive approach was used to ensure a comprehensive list of relevant articles. Given the quality of the existing reviews, we narrowed our search to studies published since 2007. The Drummond checklist was used to evaluate and categorize economic evaluation studies according to their quality. RESULTS A total of 98 articles were identified as potentially relevant to the current study. Of these 98 articles, half (n = 49) were included in this study. Six of the included articles were reviews. The remaining 43 articles reported economic evaluation studies of interventions for opioid use disorders. In general, the evidence on methadone maintenance therapy (MMT) supports previous findings that MMT is an economically advantageous opioid use disorder therapy. The economic literature comparing MMT with other opioid use disorder pharmacotherapies is limited, as is the literature on other forms of therapy. CONCLUSION With the possible exception of MMT, additional high-quality economic evaluations are needed in order to assess the relative value of existing opioid use disorder interventions.
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Affiliation(s)
- Sean M Murphy
- Department of Health Policy and Administration, Washington State University, P.O. Box 1495, Spokane, WA, 99210-1495, USA.
| | - Daniel Polsky
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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15
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Reducing hospital readmissions among medicaid patients: a review of the literature. Qual Manag Health Care 2016; 23:203-25. [PMID: 25260099 DOI: 10.1097/qmh.0000000000000043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reducing hospital readmissions is a key approach to curbing health care costs and improving quality and patient experience in the United States. Despite the proliferation of strategies and tools to reduce readmissions in the general population and among Medicare beneficiaries, few resources exist to inform initiatives to reduce readmissions among Medicaid beneficiaries. Patients covered by Medicaid also experience readmissions and are likely to experience distinct challenges related to socioeconomic status. This review aims to identify factors related to readmissions that are unique to Medicaid populations to inform efforts to reduce Medicaid readmissions. Our search yielded 254 unique results, of which 37 satisfied all review criteria. Much of the Medicaid readmissions literature focuses on patients with mental health or substance abuse issues, who are often high utilizers of health care within the Medicaid population. Risk factors such as medication noncompliance, postdischarge care environments, and substance abuse comorbidities increase the risk of readmission among Medicaid patients.
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16
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Huỳnh C, Ngamini Ngui A, Kairouz S, Lesage A, Fleury MJ. Factors associated with high use of general practitioner and psychiatrist services among patients attending an addiction rehabilitation center. BMC Psychiatry 2016; 16:258. [PMID: 27450676 PMCID: PMC4957405 DOI: 10.1186/s12888-016-0974-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 06/14/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND This study aimed to 1) identify the characteristics of individuals with substance use disorders (SUDs) who make high use of services provided by general practitioners (GP) and psychiatrists while receiving services concurrently from an addiction rehabilitation center (ARC), and 2) to compare high service users to moderate and low service users. METHODS Data were compiled for 4,407 individuals with SUDs who were receiving services from an ARC in 2004. The data came from the merging of four databases: the ARC data registry (January 1(st), 2004-December 31, 2004), the Quebec Health Insurance Board database (March 31, 2003-April 1st, 2005), the Quebec provincial database for hospitalizations (March 31, 2003-April 1st, 2005), and the Quebec National Institute of Public Health database (2004). Independent variables were grouped according to the Andersen Behavioral Model of Health Services Use: predisposing, enabling and need factors. Generalized estimating equations analyses were performed to assess the influence of individual and neighborhood-level characteristics on high use of services outside the ARC provided by GPs and psychiatrists. Benjamini-Hochberg's procedure was applied to correct for multiple comparisons. RESULTS About 97 % of individuals attending the ARC consulted a GP or a psychiatrist during the two-year study period, for a mean of 1.5 consultations per month. Findings revealed that 5 % of the sample made 26 % of all consultations over the two years, and they were defined as high users. No single predisposing factor was associated with high use. One enabling factor significantly increased the risk of being a high user of services from general practitioners and psychiatrists: receiving services at the ARC for three years prior to 2004. Four needs factors, all related to mental health diagnoses (schizophrenia, mood disorder, anxiety disorder, personality disorder), predicted high use of general practitioner and psychiatrist services. CONCLUSIONS This study found that nearly all individuals with SUDs receiving services from an ARC were users of health services from GPs and psychiatrists outside the ARC. High users most probably accessed them in inpatient settings. No previous study has compared high service users with low and moderate users among individuals with SUDs. Considering that ARCs are treating individuals with complex needs, some of whom make high use of medical professionals, both ARCs and their clients could benefit from increased collaboration and integration between the addictions and mental healthcare sectors.
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Affiliation(s)
- Christophe Huỳnh
- Centre de recherche et d'expertise en dépendance du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec, H2M 2E8, Canada. .,Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3, Canada.
| | | | - Sylvia Kairouz
- Department of Sociology and Anthropology, Concordia University, 1455 de Maisonneuve Boulevard West, Montréal, Québec H2G 1M8 Canada
| | - Alain Lesage
- Centre de recherche Fernand-Seguin, Institut universitaire en santé mentale de Montréal, 7401 Hochelaga Street, Montréal, Québec H1N 3M5 Canada
| | - Marie-Josée Fleury
- Centre de recherche et d’expertise en dépendance du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l’Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8 Canada ,Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3 Canada
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17
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Mlunde LB, Sunguya BF, Mbwambo JKK, Ubuguyu OS, Yasuoka J, Jimba M. Association of opioid agonist therapy with the initiation of antiretroviral therapy - a systematic review. Int J Infect Dis 2016; 46:27-33. [PMID: 27044520 DOI: 10.1016/j.ijid.2016.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 03/18/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES People who inject drugs are at high risk of HIV infection but often face barriers in accessing medical care including access to antiretroviral therapy (ART). Evidence is available about the effectiveness of opioid agonist therapy on drug dependency and risk behaviors. However, it remains scattered regarding access to ART among HIV-positive people who inject drugs. We conducted a systematic review to examine the association of opioid agonist therapy with ART initiation among HIV-positive people who inject drugs. METHODS We searched the literature for evidence from seven databases. We conducted a narrative synthesis and meta-analysis to examine the association of opioid agonist therapy with ART initiation. RESULTS Five out of 2,901 identified studies met the inclusion criteria. Three out of five studies reported that, HIV-positive people receiving opioid agonist therapy initiated ART more than those not receiving opioid agonist therapy. In meta-analysis, opioid agonist therapy was associated with ART initiation among HIV positive people who inject drugs (pooled odds ratio: 1.68; 95% confidence interval: 1.03-2.73). CONCLUSIONS Opioid agonist therapy is positively associated with ART initiation among HIV-positive people who inject drugs. It is important to scale up opioid agonist therapy among people who inject drugs to improve their ART initiation.
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Affiliation(s)
- Linda Beatrice Mlunde
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Bruno Fokas Sunguya
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | | | - Omary Said Ubuguyu
- Department of Psychiatry and Mental Health, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania.
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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18
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Tran BX, Nguyen LH, Nong VM, Nguyen CT, Phan HTT, Latkin CA. Behavioral and quality-of-life outcomes in different service models for methadone maintenance treatment in Vietnam. Harm Reduct J 2016; 13:4. [PMID: 26837193 PMCID: PMC4736621 DOI: 10.1186/s12954-016-0091-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest. METHODS A cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80-90% response rate). RESULTS Respondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3% on MMT for 36-60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3%). The percentage of condom use (last sexual intercourse) with primary and casual partners was lowest in the MMT at urban DHCs. Patients at the rural DHC reported very high proportions of pain/discomfort (37.8%), anxiety/depression (43.1%), and mobility (13.3%). In regression models, poorer HRQOL outcomes were found in MMT models in the rural areas or without general health care, and among those patients who were HIV positive, reported concurrent drug use, and had higher numbers of previous drug rehabilitation episodes. Mobility and anxiety/depression are factors that increased the likelihood of concurrent drug use among MMT patients. CONCLUSIONS Outcomes of MMT were diverse across different integrative service models. Policies on rapid expansion of the MMT program in Vietnam should also emphasize on the integration with comprehensive health care services including psychological supports for patients.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Vuong Minh Nong
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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19
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A Technical Assistance Framework to Facilitate the Delivery of Integrated Behavioral Health Services in Federally Qualified Health Centers (FQHCs). J Subst Abuse Treat 2015; 60:62-9. [PMID: 26422450 DOI: 10.1016/j.jsat.2015.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 08/19/2015] [Accepted: 08/28/2015] [Indexed: 11/22/2022]
Abstract
An implementation approach, featuring direct, onsite technical assistance is described, and findings from a pilot study assessing the capability of Federally Qualified Health Centers to provide integrated behavioral health services are presented. Investigators used the Behavioral Health Integration in Medical Care (BHIMC) index to measure integration at baseline and follow-up at four FQHCs in New Jersey. Results indicate that the average baseline capability score of 1.95 increased to 2.44 at follow-up, almost one-half point on the five-point BHIMC index. This pilot project demonstrates that co-occurring capability can be assessed, and system-wide technical assistance can be delivered to assist FQHCs in integrating behavioral health services. Future research should test technical assistance as an implementation strategy to promote the integration of medical care and behavioral health treatment on a wider scale.
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20
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Reducing hospital readmissions among medicaid patients: a review of the literature. Qual Manag Health Care 2015; 23:20-42. [PMID: 24368719 DOI: 10.1097/qmh.0000000000000016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reducing hospital readmissions is a key approach to curbing health care costs and improving quality and patient experience in the United States. Despite the proliferation of strategies and tools to reduce readmissions in the general population and among Medicare beneficiaries, few resources exist to inform initiatives to reduce readmissions among Medicaid beneficiaries. Patients covered by Medicaid also experience readmissions and are likely to experience distinct challenges related to socioeconomic status. This review aims to identify factors related to readmissions that are unique to Medicaid populations to inform efforts to reduce Medicaid readmissions. Our search yielded 254 unique results, of which 37 satisfied all review criteria. Much of the Medicaid readmissions literature focuses on patients with mental health or substance abuse issues, who are often high utilizers of health care within the Medicaid population. Risk factors such as medication noncompliance, postdischarge care environments, and substance abuse comorbidities increase the risk of readmission among Medicaid patients.
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21
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Lee J, Kresina TF, Campopiano M, Lubran R, Clark HW. Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. BIOMED RESEARCH INTERNATIONAL 2015; 2015:137020. [PMID: 25629034 PMCID: PMC4299453 DOI: 10.1155/2015/137020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/22/2014] [Accepted: 09/10/2014] [Indexed: 01/10/2023]
Abstract
Substance-related and addictive disorders are chronic relapsing conditions that substantially impact public health. Effective treatments for these disorders require addressing substance use/dependence comprehensively as well as other associated comorbidities. Comprehensive addressing of substance use in a medical setting involves screening for substance use, addressing substance use directly with the patient, and formulating an appropriate intervention. For alcohol dependence and opioid dependence, pharmacotherapies are available that are safe and effective when utilized in a comprehensive treatment paradigm, such as medication assisted treatment. In primary care, substance use disorders involving alcohol, illicit opioids, and prescription opioid abuse are common among patients who seek primary care services. Primary care providers report low levels of preparedness and confidence in identifying substance-related and addictive disorders and providing appropriate care and treatment. However, new models of service delivery in primary care for individuals with substance-related and addictive disorders are being developed to promote screening, care and treatment, and relapse prevention. The education and training of primary care providers utilizing approved medications for the treatment of alcohol use disorders and opioid dependence in a primary care setting would have important public health impact and reduce the burden of alcohol abuse and opioid dependence.
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Affiliation(s)
- Jinhee Lee
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA
| | - Thomas F. Kresina
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA
| | - Melinda Campopiano
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA
| | - Robert Lubran
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA
| | - H. Westley Clark
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
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22
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Han B, Polydorou S, Ferris R, Blaum CS, Ross S, McNeely J. Demographic Trends of Adults in New York City Opioid Treatment Programs--An Aging Population. Subst Use Misuse 2015; 50:1660-7. [PMID: 26584180 DOI: 10.3109/10826084.2015.1027929] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The population of adults accessing opioid treatment is growing older, but exact estimates vary widely, and little is known about the characteristics of the aging treatment population. Further, there has been little research regarding the epidemiology, healt h status, and functional impairments in this population. OBJECTIVES To determine the utilization of opioid treatment services by older adults in New York City. METHODS This study used administrative data from New York State licensed drug treatment programs to examine overall age trends and characteristics of older adults in opioid treatment programs in New York City from 1996 to 2012. RESULTS We found significant increases in utilization of opioid treatment programs by older adults in New York City. By 2012, those aged 50-59 made up the largest age group in opioid treatment programs. Among older adults there were notable shifts in demographic background including gender and ethnicity, and an increase in self-reported impairments. CONCLUSIONS/IMPORTANCE More research is needed to fully understand the specific characteristics and needs of older adults with opioid dependence.
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Affiliation(s)
- Benjamin Han
- a Division of Geriatric Medicine and Palliative Care , New York University School of Medicine , New York , New York , USA
| | - Soteri Polydorou
- b Department of Medicine , NYU Medical Center , New York , New York , USA.,c Department of Psychiatry , New York University School of Medicine , New York , New York , USA
| | - Rosie Ferris
- a Division of Geriatric Medicine and Palliative Care , New York University School of Medicine , New York , New York , USA
| | - Caroline S Blaum
- a Division of Geriatric Medicine and Palliative Care , New York University School of Medicine , New York , New York , USA
| | - Stephen Ross
- c Department of Psychiatry , New York University School of Medicine , New York , New York , USA
| | - Jennifer McNeely
- b Department of Medicine , NYU Medical Center , New York , New York , USA.,d Department of Population Health , NYU School of Medicine , New York , New York , USA
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23
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Hartzler B, Jackson TR, Jones BE, Beadnell B, Calsyn DA. Disseminating contingency management: impacts of staff training and implementation at an opiate treatment program. J Subst Abuse Treat 2013; 46:429-38. [PMID: 24462242 DOI: 10.1016/j.jsat.2013.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 12/02/2013] [Accepted: 12/10/2013] [Indexed: 12/15/2022]
Abstract
Guided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (intervention cost, feasibility, and sustainability) were assessed at study conclusion in a qualitative interview with OTP management. Intervention effectiveness was also assessed via independent chart review of trial CM implementation vs. a historical control period. Results included: 1) robust, durable increases in delivery skill, knowledge, and adoption readiness among trained staff; 2) positive managerial perspectives of intervention cost, feasibility, and sustainability; and 3) significant clinical impacts on targeted patient indices. Collective results offer support for the study's collaborative intervention design and the applied, skills-based focus of staff training processes. Implications for CM dissemination are discussed.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105.
| | - T Ron Jackson
- School of Social Work, University of Washington, Seattle, WA 98105; Evergreen Treatment Services, Seattle, WA 98134
| | - Brinn E Jones
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105
| | - Blair Beadnell
- School of Social Work, University of Washington, Seattle, WA 98105
| | - Donald A Calsyn
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105; Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 98105
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Iskandar S, van Crevel R, Hidayat T, Siregar IM, Achmad TH, van der Ven AJ, De Jong CA. Severity of psychiatric and physical problems is associated with lower quality of life in methadone patients in Indonesia. Am J Addict 2013; 22:425-31. [DOI: 10.1111/j.1521-0391.2013.00334.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/25/2011] [Accepted: 02/21/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Reinout van Crevel
- Department of General Internal Medicine and Nijmegen Institute for Inflammation, Infection and Immunity; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Teddy Hidayat
- Faculty of Medicine, Department of Psychiatry; Padjadjaran University/Hasan Sadikin Hospital; Bandung; Indonesia
| | - Ike M.P. Siregar
- Faculty of Medicine, Department of Psychiatry; Padjadjaran University/Hasan Sadikin Hospital; Bandung; Indonesia
| | - Tri H. Achmad
- Faculty of Medicine, Department of Biochemistry; Padjadjaran University/Hasan Sadikin Hospital; Bandung; Indonesia
| | - Andre J. van der Ven
- Department of General Internal Medicine and Nijmegen Institute for Inflammation, Infection and Immunity; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Cor A. De Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA); Nijmegen; The Netherlands
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Methadone dose, take home status, and hospital admission among methadone maintenance patients. J Addict Med 2013; 6:186-90. [PMID: 22694929 DOI: 10.1097/adm.0b013e3182584772] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Among patients receiving methadone maintenance treatment (MMT) for opioid dependence, receipt of unobserved dosing privileges (take homes) and adequate doses (ie, ≥ 80 mg) are each associated with improved addiction treatment outcomes, but the association with acute care hospitalization is unknown. We studied whether take-home dosing and adequate doses (ie, ≥80 mg) were associated with decreased hospital admission among patients in an MMT. METHODS We reviewed daily electronic medical records of patients enrolled in one MMT program to determine receipt of take-home doses, methadone dose 80 mg or more, and hospital admission date. Nonlinear mixed-effects logistic regression models were used to evaluate whether take-home doses or dose 80 mg or more on a given day were associated with hospital admission on the subsequent day. Covariates in adjusted models included age, sex, race/ethnicity, human immunodeficiency virus status, medical illness, mental illness, and polysubstance use at program admission. RESULTS Subjects (n = 138) had the following characteristics: mean age 43 years; 52% female; 17% human immunodeficiency virus-infected; 32% medical illness; 40% mental illness; and 52% polysubstance use. During a mean follow-up of 20 months, 42 patients (30%) accounted for 80 hospitalizations. Receipt of take homes was associated with significantly lower odds of a hospital admission (adjusted odds ratio [AOR] = 0.26; 95% confidence interval [CI], 0.11-0.62), whereas methadone dose 80 mg or more was not (AOR = 1.01; 95% CI, 0.56-1.83). CONCLUSIONS Among MMT patients, receipt of take homes, but not dose of methadone, was associated with decreased hospital admission. Take-home status may reflect not only patients' improved addiction outcomes but also reduced health care utilization.
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Rowe TA, Jacapraro JS, Rastegar DA. Entry into primary care-based buprenorphine treatment is associated with identification and treatment of other chronic medical problems. Addict Sci Clin Pract 2012. [PMID: 23186008 PMCID: PMC3509402 DOI: 10.1186/1940-0640-7-22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Buprenorphine is an effective treatment for opioid dependence that can be provided in a primary care setting. Offering this treatment may also facilitate the identification and treatment of other chronic medical conditions. METHODS We retrospectively reviewed the medical records of 168 patients who presented to a primary care clinic for treatment of opioid dependence and who received a prescription for sublingual buprenorphine within a month of their initial visit. RESULTS Of the 168 new patients, 122 (73%) did not report having an established primary care provider at the time of the initial visit. One hundred and twenty-five patients (74%) reported at least one established chronic condition at the initial visit. Of the 215 established diagnoses documented on the initial visit, 146 (68%) were not being actively treated; treatment was initiated for 70 (48%) of these within one year. At least one new chronic medical condition was identified in 47 patients (28%) during the first four months of their care. Treatment was initiated for 39 of the 54 new diagnoses (72%) within the first year. CONCLUSIONS Offering treatment for opioid dependence with buprenorphine in a primary care practice is associated with the identification and treatment of other chronic medical conditions.
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Walley AY, Paasche-Orlow M, Lee EC, Forsythe S, Chetty VK, Mitchell S, Jack BW. Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis. J Addict Med 2012; 6:50-6. [PMID: 21979821 PMCID: PMC6034987 DOI: 10.1097/adm.0b013e318231de51] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Hospital discharge may be an opportunity to intervene among patients with substance use disorders to reduce subsequent hospital utilization. This study determined whether having a substance use disorder diagnosis was associated with subsequent acute care hospital utilization. METHODS We conducted an observational cohort study among 738 patients on a general medical service at an urban, academic, safety-net hospital. The main outcomes were rate and risk of acute care hospital utilization (emergency department visit or hospitalization) within 30 days of discharge. The main independent variable was presence of a substance use disorder primary or secondary discharge diagnosis code at the index hospitalization. RESULTS At discharge, 17% of subjects had a substance use disorder diagnosis. These patients had higher rates of recurrent acute care hospital utilization than patients without substance use disorder diagnoses (0.63 vs 0.32 events per subject at 30 days, P < 0.01) and increased risk of any recurrent acute care hospital utilization (33% vs 22% at 30 days, P < 0.05). In adjusted Poisson regression models, the incident rate ratio at 30 days was 1.49 (95% confidence interval, 1.12-1.98) for patients with substance use disorder diagnoses compared with those without. In subgroup analyses, higher utilization was attributable to those with drug diagnoses or a combination of drug and alcohol diagnoses, but not to those with exclusively alcohol diagnoses. CONCLUSIONS Medical patients with substance use disorder diagnoses, specifically those with drug use-related diagnoses, have higher rates of recurrent acute care hospital utilization than those without substance use disorder diagnoses.
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Affiliation(s)
- Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA.
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Emergency department utilization among a cohort of HIV-positive injecting drug users in a Canadian setting. J Emerg Med 2011; 43:236-43. [PMID: 21719229 DOI: 10.1016/j.jemermed.2011.05.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/21/2010] [Accepted: 05/20/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-positive injection drug users (IDUs) are known to be at risk for multiple medical problems that may necessitate emergency department (ED) use; however, the relative contribution of HIV disease vs. injection-related complications has not been well described. OBJECTIVES We examined factors associated with ED use among a prospective cohort of HIV-positive IDUs in a Canadian setting. METHODS We enrolled HIV-positive IDUs into a community-recruited prospective cohort study. We modeled factors associated with the time to first ED visit using Cox regression to determine factors independently associated with ED use. In sub-analyses, we examined ED diagnoses and subsequent hospital admission rates. RESULTS Between December 5, 2005 and April 30, 2008, 428 HIV-positive IDUs were enrolled, among whom the cumulative incidence of ED use was 63.7% (95% confidence interval [CI] 59.1-68.3%) at 12 months after enrollment. Factors independently associated with time to first ED visit included: unstable housing (hazard ratio [HR] 1.5; 95% CI 1.1-2.0) and reporting being unable to obtain needed health care services (HR 2.2; 95% CI 1.2-4.1), whereas CD4 count and viral load were non-significant. Skin and soft tissue infections accounted for the greatest proportion of ED visits (17%). Of the 2461 visits to the ED, 419 (17%) were admitted to the hospital. CONCLUSIONS High rates of ED use were observed among HIV-positive IDUs, a behavior that was predicted by unstable housing and limited access to primary care. Factors other than HIV infection seem to be driving ED use among this population in the post-highly active antiretroviral therapy era.
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Directly observed antiretroviral therapy improves adherence and viral load in drug users attending methadone maintenance clinics: a randomized controlled trial. Drug Alcohol Depend 2011; 113:192-9. [PMID: 20832196 PMCID: PMC3003759 DOI: 10.1016/j.drugalcdep.2010.07.025] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/30/2010] [Accepted: 07/30/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if directly observed antiretroviral therapy (DOT) is more efficacious than self-administered therapy for improving adherence and reducing HIV viral load (VL) among methadone-maintained opioid users. DESIGN Two-group randomized trial. SETTING Twelve methadone maintenance clinics with on-site HIV care in the Bronx, New York. PARTICIPANTS HIV-infected adults prescribed combination antiretroviral therapy. MAIN OUTCOMES MEASURES Between group differences at four assessment points from baseline to week 24 in: (1) antiretroviral adherence measured by pill count, (2) VL, and (3) proportion with undetectable VL (< 75 copies/ml). RESULTS Between June 2004 and August 2007, we enrolled 77 participants. Adherence in the DOT group was higher than in the control group at all post-baseline assessment points; by week 24 mean DOT adherence was 86% compared to 56% in the control group (p < 0.0001). Group differences in mean adherence remained significant after stratifying by baseline VL (detectable versus undetectable). In addition, during the 24-week intervention, the proportion of DOT participants with undetectable VL increased from 51% to 71%. CONCLUSIONS Among HIV-infected opioid users, antiretroviral DOT administered in methadone clinics was efficacious for improving adherence and decreasing VL, and these improvements were maintained over a 24-week period. DOT should be more widely available to methadone patients.
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Altice FL, Kamarulzaman A, Soriano VV, Schechter M, Friedland GH. Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet 2010; 376:367-87. [PMID: 20650518 PMCID: PMC4855280 DOI: 10.1016/s0140-6736(10)60829-x] [Citation(s) in RCA: 378] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
HIV-infected drug users have increased age-matched morbidity and mortality compared with HIV-infected people who do not use drugs. Substance-use disorders negatively affect the health of HIV-infected drug users, who also have frequent medical and psychiatric comorbidities that complicate HIV treatment and prevention. Evidence-based treatments are available for the management of substance-use disorders, mental illness, HIV and other infectious complications such as viral hepatitis and tuberculosis, and many non-HIV-associated comorbidities. Tuberculosis co-infection in HIV-infected drug users, including disease caused by drug-resistant strains, is acquired and transmitted as a consequence of inadequate prescription of antiretroviral therapy, poor adherence, and repeated interfaces with congregate settings such as prisons. Medication-assisted therapies provide the strongest evidence for HIV treatment and prevention efforts, yet are often not available where they are needed most. Antiretroviral therapy, when prescribed and adherence is at an optimum, improves health-related outcomes for HIV infection and many of its comorbidities, including tuberculosis, viral hepatitis, and renal and cardiovascular disease. Simultaneous clinical management of multiple comorbidities in HIV-infected drug users might result in complex pharmacokinetic drug interactions that must be adequately addressed. Moreover, interventions to improve adherence to treatment, including integration of health services delivery, are needed. Multifaceted, interdisciplinary approaches are urgently needed to achieve parity in health outcomes in HIV-infected drug users.
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Affiliation(s)
- Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, Yale University, New Haven, CT 06510-2283, USA.
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Are opioid dependence and methadone maintenance treatment (MMT) documented in the medical record? A patient safety issue. J Gen Intern Med 2009; 24:1007-11. [PMID: 19578820 PMCID: PMC2726880 DOI: 10.1007/s11606-009-1043-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 05/11/2009] [Accepted: 06/04/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Opioid-dependent patients often have co-occurring chronic illnesses requiring medications that interact with methadone. Methadone maintenance treatment (MMT) is typically provided separately from medical care. Hence, coordination of medical care and substance use treatment is important to preserve patient safety. OBJECTIVE To identify potential safety risks among MMT patients engaged in medical care by evaluating the frequency that opioid dependence and MMT documentation are missing in medical records and characterizing potential medication-methadone interactions. METHODS Among patients from a methadone clinic who received primary care from an affiliated, but separate, medical center, we reviewed electronic medical records for documentation of methadone, opioid dependence, and potential drug-methadone interactions. The proportions of medical records without opioid dependence and methadone documentation were estimated and potential medication-methadone interactions were identified. RESULTS Among the study subjects (n = 84), opioid dependence documentation was missing from the medical record in 30% (95% CI, 20%-41%) and MMT documentation was missing from either the last primary care note or the last hospital discharge summary in 11% (95% CI, 5%-19%). Sixty-nine percent of the study subjects had at least 1 medication that potentially interacted with methadone; 19% had 3 or more potentially interacting medications. CONCLUSION Among patients receiving MMT and medical care at different sites, documentation of opioid dependence and MMT in the medical record occurs for the majority, but is missing in a substantial number of patients. Most of these patients are prescribed medications that potentially interact with methadone. This study highlights opportunities for improved coordination between medical care and MMT.
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Abstract
AIMS Buprenorphine is an effective alternative to methadone for treatment of opioid dependence, but economic concerns represent a barrier to implementation. The economic impacts of buprenorphine adoption by the US Veterans Health Administration (VHA) were examined. DESIGN Prescriptions of buprenorphine, methadone treatment visits, health-care utilization and cost, and diagnostic data were obtained for 2005. FINDINGS VHA dispensed buprenorphine to 606 patients and methadone to 8191 other patients during the study year. An analysis that controlled for age and diagnosis found that the mean cost of care for the 6 months after treatment initiation was $11,597 for buprenorphine and $14,921 for methadone (P < 0.001). Cost was not significantly different in subsequent months. The first 6 months of buprenorphine treatment included an average of 66 ambulatory care visits, significantly fewer than the 137 visits in methadone treatment (P < 0.001). In subsequent months, buprenorphine patients had 8.4 visits, significantly fewer than the 21.0 visits of methadone patients (P < 0.001). Compared to new methadone episodes, new buprenorphine episodes had 0.634 times the risk of ending [95% confidence interval 0.547-0.736]. Implementation of buprenorphine treatment was not associated with an influx of new opioid-dependent patients. CONCLUSION Despite the higher cost of medication, buprenorphine treatment was no more expensive than methadone treatment. VHA methadone treatment costs were higher than reported by other providers. Although new buprenorphine treatment episodes lasted longer than new methadone episodes, buprenorphine is recommended for more adherent patients.
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Affiliation(s)
- Paul G Barnett
- Veterans Affairs Health Economics Resource Center and Department of Health Research and Policy, Stanford University, CA, USA.
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Nyamathi A, Compton P, Cohen A, Marfisee M, Shoptaw S, Greengold B, de Castro V, Reaves M, Hasson A, George D, Leake B. Correlates of hospitalization for alcohol-using methadone-maintained persons with physical health problems. West J Nurs Res 2009; 31:525-43. [PMID: 19129517 DOI: 10.1177/0193945908328784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This cross-sectional study (n = 190) examined correlates of hospitalization for physical health problems among methadone maintenance therapy (MMT) clients with a history of alcohol abuse. The study was derived from baseline data collected for a longitudinal trial assessing the effect of motivational interviewing among alcohol-abusing adults undergoing MMT. The sample included clients who were 18-55 years of age, abusing alcohol, and receiving MMT from five large methadone maintenance clinics in the Los Angeles area. A structured questionnaire was used to collect the data. Correlates of hospitalization in logistic regression analysis included lack of social support, recent victimization, age of first alcohol use, chronic severe pain in the previous 6 months, not having children, and ethnicity. Identification of hospitalization risk factors among alcohol-abusing MMT clients is a first step to developing risk-reducing interventions designed to lower hospitalization rates in this population.
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Kresina TF, Sylvestre D, Seeff L, Litwin AH, Hoffman K, Lubran R, Clark HW. Hepatitis infection in the treatment of opioid dependence and abuse. Subst Abuse 2008; 1:15-61. [PMID: 25977607 PMCID: PMC4395041 DOI: 10.4137/sart.s580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Many new and existing cases of viral hepatitis infections are related to injection drug use. Transmission of these infections can result directly from the use of injection equipment that is contaminated with blood containing the hepatitis B or C virus or through sexual contact with an infected individual. In the latter case, drug use can indirectly contribute to hepatitis transmission through the dis-inhibited at-risk behavior, that is, unprotected sex with an infected partner. Individuals who inject drugs are at-risk for infection from different hepatitis viruses, hepatitis A, B, or C. Those with chronic hepatitis B virus infection also face additional risk should they become co-infected with hepatitis D virus. Protection from the transmission of hepatitis viruses A and B is best achieved by vaccination. For those with a history of or who currently inject drugs, the medical management of viral hepatitis infection comprising screening, testing, counseling and providing care and treatment is evolving. Components of the medical management of hepatitis infection, for persons considering, initiating, or receiving pharmacologic therapy for opioid addiction include: testing for hepatitis B and C infections; education and counseling regarding at-risk behavior and hepatitis transmission, acute and chronic hepatitis infection, liver disease and its care and treatment; vaccination against hepatitis A and B infection; and integrative primary care as part of the comprehensive treatment approach for recovery from opioid abuse and dependence. In addition, participation in a peer support group as part of integrated medical care enhances treatment outcomes. Liver disease is highly prevalent in patient populations seeking recovery from opioid addiction or who are currently receiving pharmacotherapy for opioid addiction. Pharmacotherapy for opioid addiction is not a contraindication to evaluation, care, or treatment of liver disease due to hepatitis virus infection. Successful pharmacotherapy for opioid addiction stabilizes patients and improves patient compliance to care and treatment regimens as well as promotes good patient outcomes. Implementation and integration of effective hepatitis prevention programs, care programs, and treatment regimens in concert with the pharmacological therapy of opioid addiction can reduce the public health burdens of hepatitis and injection drug use.
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Affiliation(s)
- Thomas F Kresina
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Diana Sylvestre
- Department of Medicine, University of California, San Francisco and Organization to Achieve Solutions In Substance Abuse (O.A.S.I.S.) Oakland, CA
| | - Leonard Seeff
- Division of Digestive Diseases and Nutrition, National Institute on Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, DHHS, Bethesda, MD
| | - Alain H Litwin
- Division of Substance Abuse, Albert Einstein College of Medicine, Montefiore Medical Center Bronx, NY
| | - Kenneth Hoffman
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Robert Lubran
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - H Westley Clark
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
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Du WJ, Xiang YT, Wang ZM, Chi Y, Zheng Y, Luo XN, Cai ZJ, Ungvari GS, Gerevich J. Socio-demographic and clinical characteristics of 3129 heroin users in the first methadone maintenance treatment clinic in China. Drug Alcohol Depend 2008; 94:158-64. [PMID: 18164146 DOI: 10.1016/j.drugalcdep.2007.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 11/13/2007] [Accepted: 11/13/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to determine the characteristics of heroin users in the first methadone maintenance treatment (MMT) clinic in China. METHODS In a retrospective chart review, the notes of 3127 heroin users who received both detoxification and MMT at the clinic were analyzed. Their socio-demographic and clinical data were collected, and the frequency of human immunodeficiency virus (HIV), Hepatitis C virus (HCV), and syphilis infections was investigated. RESULTS The main findings are as follows: (1) 66.5% of the patients were younger than 35 years; (2) 55.1% were married at admission; (3) 32% were non-local residents; (4) the majority had high school level education, a history of smoking and alcohol consumption prior to the initial heroin use, and did not have stable jobs; (5) 28.4% were self-employed; (6) 5.4% of the sample had total hearing loss coupled with loss of speech; (7) 83.4% sniffed heroin or injected it intravenously at the time of admission, but 87.2% had smoked the drug when they first began abusing it; (8) a significant proportion of the patients were infected with HIV, HCV, and syphilis. CONCLUSIONS Some of the above findings are not consistent with the results of previous studies conducted in Western countries and China. The unique socio-cultural and clinical characteristics of heroin abusers in different regions of China should be considered when MMT services are planned.
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Affiliation(s)
- Wan-Jun Du
- Chinese National Drug Dependence Treatment Center affiliated with Beijing Anding Hospital, Capital Medical University, Beijing, China
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