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Ivasiy R, Madden LM, Johnson KA, Machavariani E, Ahmad B, Oliveros D, Tan J, Kil N, Altice FL. Retention and dropout from sublingual and extended-release buprenorphine treatment: A comparative analysis of data from a nationally representative sample of commercially-insured people with opioid use disorder in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2025; 138:104748. [PMID: 40020306 PMCID: PMC12045481 DOI: 10.1016/j.drugpo.2025.104748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 02/18/2025] [Accepted: 02/18/2025] [Indexed: 03/03/2025]
Abstract
BACKGROUND AND AIMS Maintenance on medications for opioid use disorder, particularly buprenorphine, is critical for reducing overdose risk and improving health outcomes in the United States. This study evaluates retention and dropout probabilities between sublingual buprenorphine (SL-BUP) and extended-release buprenorphine (XR-BUP) among commercially-insured individuals with opioid use disorder (OUD). DESIGN AND SETTING A retrospective cohort study using Meretive™ Markeskan® claims data from 2019 to 2020. A multi-state Markov model assessed transitions between treatment states over 12 months. PARTICIPANTS The study included 58,933 individuals aged 18-64 years with OUD, initiating SL-BUP (n = 57,520) or XR-BUP (n = 1,413). XR-BUP patients were divided into XR-BUP only (n = 684; 49 %) and XR-BUP with supplemental SL-BUP (XR-BUP+sSL; n = 729; 51 %). MEASUREMENTS Primary outcomes included probabilities of remaining in treatment or transitioning between states at 1, 3, 6, and 12 months. The impact of dosage and days of supply on retention was also examined. RESULTS The probability of permanent treatment dropout at 6 months was similar for SL-BUP (38.59 %, 95 % CI: 37.9 %-39.4 %) and XR-BUP (41.3 % 95 %CI: 36.8 %-46.1 %), yet the probability of remaining in treatment was significantly higher for SL-BUP than XR-BUP (49.5 %; 95 %CI: 48.8 %-50.1 % vs. 13.5 % 95 % CI: 10.5 %-16.5 %). The high proportion of individuals initially prescribed XR-BUP later transitioned to SL-BUP. Higher doses and longer days supplied of SL-BUP reduced dropout rates. Among patients receiving ≥16 mg/day and ≥28 days, dropout probabilities were 5.7 % (95 % CI: 5.4 %-6.0 %) at 1 month, 15.4 % (95 % CI: 14.8 %-16.2 %) at 3 months, 28.0 % (95 % CI: 26.9 %-29.2 %) at 6 months, and 47.8 % (95 %CI: 45.2 %-49.5 %) at 12 months. In contrast, patients prescribed <16 mg/day and <28 days had a 46.3 % (95 %CI: 45.0 %-47.6 %) dropout rate by 6 months. CONCLUSION SL-BUP demonstrates higher retention rates and lower dropout compared to XR-BUP in real-world settings. Optimizing SL-BUP dosing and providing extended supplies can improve retention and reduce treatment discontinuation.
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Affiliation(s)
- Roman Ivasiy
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States.
| | - Lynn M Madden
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States
| | - Kimberly A Johnson
- College of Behavioral and Community Science, Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, United States
| | - Eteri Machavariani
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Bachar Ahmad
- Yale School of Medicine, New Haven, CT, United States
| | - David Oliveros
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Jiale Tan
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Natalie Kil
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States; Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States; Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, United States
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Stahler GJ, Mennis J, Stein LAR, Belenko S, Rohsenow DJ, Grunwald HE, Brinkley-Rubinstein L, Martin RA. Treatment outcomes associated with medications for opioid use disorder (MOUD) among criminal justice-referred admissions to residential treatment in the U.S., 2015-2018. Drug Alcohol Depend 2022; 236:109498. [PMID: 35605535 DOI: 10.1016/j.drugalcdep.2022.109498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
AIMS To examine the use and association of medications for opioid use disorder (MOUD) with treatment completion and retention for criminal justice referred (CJR) admissions to residential treatment. METHODS A retrospective analysis of the Treatment Episode Dataset-Discharge (TEDS-D; 2015-2018) for adults (N = 205,348) admitted to short-term (ST) (< 30 days) or long-term (LT) (>30 days) residential treatment for OUD. Outcomes were MOUD in treatment plans, and treatment completion and retention (ST >10 days; LT > 90 days). Logistic regression analyses were conducted separately for ST and LT settings. RESULTS CJR admissions were less likely to have MOUD than non-CJR admissions (ST, 11% vs. 21%; LT, 10% vs. 24%, respectively) and were more likely to complete and be retained in treatment. In ST settings, MOUD was associated with higher likelihood of treatment completion and retention. In LT settings, MOUD was associated with higher likelihood of treatment retention and lower likelihood of treatment completion. These associations tended to be slightly weaker for CJR admissions, with the exception of treatment completion in LT settings, but the moderating effect size of CJR status in all models was very small. Small differences in the moderating effect of CJR status by race and ethnicity were observed in LT settings. CONCLUSIONS MOUD is greatly under-utilized for CJR patients, and given that MOUD was associated with positive outcomes, there is a critical need to find ways to increase access to MOUD for CJR patients in residential treatment. Race and ethnicity appear to have relatively little impact on outcomes.
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Affiliation(s)
- Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, United States.
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, United States
| | - L A R Stein
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States; Department of Psychology, The University of Rhode Island, United States
| | - Steven Belenko
- Department of Criminal Justice, Temple University, United States
| | - Damaris J Rohsenow
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States
| | | | | | - Rosemarie A Martin
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States
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Bowser DM, Henry BF, McCollister KE. Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review. Implement Sci 2021; 16:26. [PMID: 33706780 PMCID: PMC7953634 DOI: 10.1186/s13012-021-01094-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study is a systematic literature review of cost analyses conducted within implementation studies on behavioral health services. Cost analysis of implementing evidence-based practices (EBP) has become important within implementation science and is critical for bridging the research to practice gap to improve access to quality healthcare services. Costing studies in this area are rare but necessary since cost can be a barrier to implementation and sustainment of EBP. Methods We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and applied the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Key search terms included: (1) economics, (2) implementation, (3) EBP, and (4) behavioral health. Terms were searched within article title and abstracts in: EconLit, SocINDEX, Medline, and PsychINFO. A total of 464 abstracts were screened independently by two authors and reduced to 37 articles using inclusion and exclusion criteria. After a full-text review, 18 articles were included. Results Findings were used to classify costs into direct implementation, direct services, and indirect implementation. While all studies included phases of implementation as part of their design, only five studies examined resources across multiple phases of an implementation framework. Most studies reported direct service costs associated with adopting a new practice, usually summarized as total EBP cost, cost per client, cost per clinician, and/or cost per agency. For studies with detailed analysis, there were eleven direct cost categories represented. For five studies that reported costs per child served, direct implementation costs varied from $886 to $9470 per child, while indirect implementation costs ranged from $897 to $3805 per child. Conclusions This is the first systematic literature review to examine costs of implementing EBP in behavioral healthcare settings. Since 2000, 18 studies were identified that included a cost analysis. Given a wide variation in the study designs and economic methods, comparison across studies was challenging, which is a major limitation in the field, as it becomes difficult to replicate studies or to estimate future costs to inform policy decisions related to budgeting. We recommend future economic implementation studies to consider standard economic costing methods capturing costs across implementation framework phases to support comparisons and replicability.
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Affiliation(s)
- Diana M Bowser
- Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA
| | - Brandy F Henry
- Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA. .,School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA.
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., CRB 1019, Miami, FL, 33136, USA
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Modelling internet security software usage among undergraduate students. VINE JOURNAL OF INFORMATION AND KNOWLEDGE MANAGEMENT SYSTEMS 2018. [DOI: 10.1108/vjikms-09-2016-0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Calzone KA, Jenkins J, Culp S, Badzek L. Hospital nursing leadership-led interventions increased genomic awareness and educational intent in Magnet settings. Nurs Outlook 2017; 66:244-253. [PMID: 29544651 DOI: 10.1016/j.outlook.2017.10.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 10/23/2017] [Accepted: 10/30/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND The Precision Medicine Initiative will accelerate genomic discoveries that improve health care, necessitating a genomic competent workforce. PURPOSE This study assessed leadership team (administrator/educator) year-long interventions to improve registered nurses' (RNs) capacity to integrate genomics into practice. METHODS We examined genomic competency outcomes in 8,150 RNs. FINDINGS Awareness and intention to learn more increased compared with controls. Findings suggest achieving genomic competency requires a longer intervention and support strategies such as infrastructure and policies. Leadership played a role in mobilizing staff, resources, and supporting infrastructure to sustain a large-scale competency effort on an institutional basis. DISCUSSION Results demonstrate genomic workforce competency can be attained with leadership support and sufficient time. Our study provides evidence of the critical role health-care leaders play in facilitating genomic integration into health care to improve patient outcomes. Genomics' impact on quality, safety, and cost indicate a leader-initiated national competency effort is achievable and warranted.
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Affiliation(s)
- Kathleen A Calzone
- National Institutes of Health, National Cancer Institute, Center for Cancer Research, Bethesda, MD.
| | - Jean Jenkins
- National Institutes of Health, National Human Genome Research Institute, Genomic Healthcare Branch, Bethesda, MD
| | - Stacey Culp
- Department of Statistics, West Virginia University, Morgantown, WV
| | - Laurie Badzek
- University of North Carolina Wilmington School of Nursing, Wilmington, NC
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Stirman SW, Gutner CA, Langdon K, Graham JR. Bridging the Gap Between Research and Practice in Mental Health Service Settings: An Overview of Developments in Implementation Theory and Research. Behav Ther 2016; 47:920-936. [PMID: 27993341 DOI: 10.1016/j.beth.2015.12.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
Twenty years after Sobell's (1996) influential call to integrate advances in behavior therapy into clinical settings, significant progress has been made in implementation science. In this narrative review, we provide an overview of implementation research findings and highlight recent findings that can inform efforts to bridge the gap between research and practice in mental health service settings. Key findings are summarized, organized according to levels of influence described in two implementation frameworks: The Exploration, Planning, Implementation, and Sustainment Framework (EPIS; Aarons et al., 2011) and the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009). Important levels of influence to consider when implementing new treatments include the outer context, inner context, characteristics of the individual, and characteristics of the innovation. Research on strategies to prepare clinicians to deliver evidence-based psychosocial treatments (EBPTs) and to address contextual barriers to implementation at each level is described, with discussion of implications for the implementation of EBPTs and next steps for research.
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Affiliation(s)
| | - Cassidy A Gutner
- National Center for PTSD, VA Boston Healthcare System; Boston University
| | - Kirsten Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI
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Decision-to-Implement Worksheet for Evidence-based Interventions: From the WWAMI Region Practice and Research Network. J Am Board Fam Med 2016; 29:553-62. [PMID: 27613788 PMCID: PMC5065058 DOI: 10.3122/jabfm.2016.05.150327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/21/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Health-related scientific discoveries are often not applied in clinical settings after publication, even when recommended by a trusted journal or professional association. This article describes an assessment tool we developed for use by primary care clinicians and practice administrators to evaluate whether to implement recommended evidence-based interventions in their practices. METHODS We used dissemination and implementation theory to develop a worksheet to guide decision making about whether interventions are suitable for implementation in primary care practice settings. We tested the tool by analyzing how members of a primary care practice-based research network rated 4 evidence-based interventions. RESULTS The median likelihood of implementation ranged from 2 to 3.5 on a scale of 1 (low) to 5 (high). Raters' level of agreement with statements about 3 intervention characteristics was associated (P < .05) with a higher likelihood of implementation using Spearman rank-order correlation: simple to implement, testable before fully implementing, and modifiable to meet the needs of the practice. Raters found the worksheet helpful in thinking through potential implementation, especially the prompts about modifiability and relevance to the practice's patients and priorities. CONCLUSIONS The Decision-to-Implement Worksheet provides a new resource for primary care practices that want to assess whether evidence-based interventions are suitable to adopt or adapt to meet their needs.
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Pickard KE, Kilgore AN, Ingersoll BR. Using Community Partnerships to Better Understand the Barriers to Using an Evidence-Based, Parent-Mediated Intervention for Autism Spectrum Disorder in a Medicaid System. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2016; 57:391-403. [PMID: 27216766 DOI: 10.1002/ajcp.12050] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Service use disparities have been noted to impede under-resourced families' ability to access high-quality services for their child with autism spectrum disorder (ASD). These disparities are particularly relevant for parent-mediated interventions and may suggest a lack of fit between these interventions and the needs of under-resourced community settings. This study used Roger's Diffusion of Innovations theory to guide community partnerships aimed at understanding the perceived compatibility, complexity, and relative advantage of using an evidence-based, parent-mediated intervention (Project ImPACT) within a Medicaid system. Three focus groups were conducted with 16 Medicaid-eligible parents, and three focus groups were conducted with 16 ASD providers operating within a Medicaid system. Across all groups, parents and providers reported general interest in using Project ImPACT. However, primary themes emerged regarding the need to (a) reduce the complexity of written materials; (b) allow for a more flexible program delivery; (c) ensure a strong parent-therapist alliance; (d) involve the extended family; and (e) help families practice the intervention within their preexisting routines. Results are discussed as they relate to the design and fit of evidence-based, parent-mediated interventions for under-resourced community settings.
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Affiliation(s)
| | - Amanda N Kilgore
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Brooke R Ingersoll
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Kasperavičiūtė-Černiauskienė R, Serafinas D. The adoption of ISO 9001 standard within higher education institutions in Lithuania: innovation diffusion approach. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2016. [DOI: 10.1080/14783363.2016.1164012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Dalius Serafinas
- Management Department, Vilnius University, Saulėtekis avenue 9, 10222 Vilnius, Lithuania
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Fields D, Roman P. Longitudinal Examination of Medical Staff Utilization in Substance Use Disorder Treatment Organizations. J Subst Abuse Treat 2015. [PMID: 26219681 DOI: 10.1016/j.jsat.2015.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined changes in utilization of medical staff within organizations specializing in treatment of patients with substance use disorder (SUD) at two points in time (2007 and 2010). Utilization was calculated as the number of hours paid weekly for psychiatrists, physicians, nurses, and other medical staff working as employees or on contract. Study data come from a longitudinal national sample of 274 substance use disorder treatment centers. Average utilization of medical staff by these SUD treatment organizations increased by 26% from 2007 to 2010. The results showed that growing SUD treatment centers that obtained more referrals from health care providers, used case managers to coordinate comprehensive approaches to patient care, provided medication assisted treatment (MAT), and that were connected more closely with hospitals made increased use of medical staff over the 2007-2010 period. In 2010, these organizations seem to have been moving in directions consistent with trends forecasted for the SUD treatment environment after implementation of the Affordable Care Act.
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Affiliation(s)
- Dail Fields
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia, Athens, GA, USA.
| | - Paul Roman
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia, Athens, GA, USA; Department of Sociology, University of Georgia, Athens, GA, USA.
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