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Clarke DE, Ibrahim A, Doty B, Patel S, Gibson D, Pagano A, Thompson L, Goldstein AB, Vocci F, Schwartz RP. Addiction Medicine Practice-Based Research Network (AMNet): Assessment Tools and Quality Measures. Subst Abuse Rehabil 2021; 12:27-39. [PMID: 34211312 PMCID: PMC8240849 DOI: 10.2147/sar.s305972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The need for innovative approaches to address the opioid epidemic in the United States is widely recognized. Many challenges exist to addressing this epidemic, including the obstacles outpatient substance use treatment practices face in implementing measurement-based care (MBC), quality measurement systems, and evidence-based treatments. Also, there are insufficient opportunities for clinicians in these settings to participate in research, resulting in diminished translation of research findings into community-based practice. To address these challenges, the Addiction Medicine Practice-Based Research Network (AMNet) was developed to facilitate the uptake of MBC in outpatient practices via implementation of patient-reported assessments and quality of care performance measures to improve patient outcomes. This network will offer clinicians in outpatient settings (not incuding opioid treatment programs [OTPs]) the opportunity to participate in future substance use disorder treatment research studies. METHODS A key step in the development of AMNet was the selection of substance use-specific assessment tools and quality of care performance measures for incorporation into the American Psychiatric Association's mental health patient registry, PsychPRO. A scoping review and multi-step consensus-based process were used to identify, review and select candidate assessment tools and quality of care performance measures for opioid use disorders (OUD) and substance use disorders (SUD). RESULTS Following a consensus-based methodology, 12 standardized assessment tools and 3 quality of care performance measures for OUD and SUD were selected to help facilitate the implementation of MBC and quality improvement for AMNet participants. These tools were further categorized as core and optional. CONCLUSION By offering a collection of carefully vetted assessment tools and quality measures through PsychPRO, AMNet will help participating clinicians with the systematic uptake of MBC and delivery of evidence-based treatment for patients with SUD. Also, AMNet will act as a centralized repository of data collected from patients and clinicians in non-OTP outpatient addiction medicine practices and serve as a platform for opioid treatment research.
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Affiliation(s)
- Diana E Clarke
- Division of Research, American Psychiatric Association, Washington, DC, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adila Ibrahim
- Social Research Center, Friends Research Institute, Baltimore, MD, USA
| | - Benjamin Doty
- Division of Research, American Psychiatric Association, Washington, DC, USA
| | - Sejal Patel
- Division of Research, American Psychiatric Association, Washington, DC, USA
| | - Debbie Gibson
- Division of Research, American Psychiatric Association, Washington, DC, USA
| | - Anna Pagano
- Quality and Science Department,American Society of Addiction Medicine, Rockville, MD, USA
| | - Laura Thompson
- Division of Research, American Psychiatric Association, Washington, DC, USA
| | - Amy B Goldstein
- Prevention Research Branch,National Institute on Drug Abuse, Bethesda, MD, USA
| | - Frank Vocci
- Social Research Center, Friends Research Institute, Baltimore, MD, USA
| | - Robert P Schwartz
- Social Research Center, Friends Research Institute, Baltimore, MD, USA
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Karnik NS, Campbell CI, Curtis ME, Fiellin DA, Ghitza U, Hefner K, Hser YI, McHugh RK, Murphy SM, McPherson SM, Moran L, Mooney LJ, Wu LT, Shmueli-Blumberg D, Shulman M, Schwartz RP, Stephens KA, Watkins KE, Marsden J. Core outcomes set for research on the treatment of opioid use disorder (COS-OUD): the National Institute on Drug Abuse Clinical Trials Network protocol for an e-Delphi consensus study. Trials 2021; 22:102. [PMID: 33509278 PMCID: PMC7841754 DOI: 10.1186/s13063-021-05051-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A lack of consensus on the optimal outcome measures to assess the efficacy and effectiveness of interventions for the treatment of opioid use disorder (OUD) has hampered the pooling of research data for evidence synthesis and clinical guidelines. A core outcome set (COS) is a minimum set of outcome measures that are recommended for all studies of a particular condition. The National Drug Abuse Treatment Clinical Trials Network (CTN) Core Outcome Set for OUD (COS-OUD) is a development study to identify core constructs, meaningful outcomes, and their optimal measurement for all efficacy and effectiveness studies of OUD treatment and service delivery. METHODS/DESIGN Overseen by an expert workgroup, a modified, stepwise, e-Delphi methodology will be used to gain consensus among a panel of clinical practitioners and researchers involved in the treatment of OUD, who are members of the CTN. Sequential rounds of anonymous, online questionnaires will be used to identify, rate the importance of, and refine a core outcome set. A consensus threshold will be achieved if at least 70% of the panel rate the measure as critical for inclusion in the COS-OUD. Where consensus is not reached or there are suggestions for new measures, these will be brought forward to a further round of review prior to a consensus meeting. Products from this study will be communicated via peer-reviewed scientific journals and conferences. DISCUSSION This initiative will develop a COS for OUD intervention trials, treatment studies, and service delivery and will support the pooling of research and clinical practice data and efforts to develop measurement-based care within the OUD treatment cascade. TRIAL REGISTRATION http://www.comet-initiative.org/Studies/Details/1579.
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Affiliation(s)
- Niranjan S. Karnik
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd., Suite 600, Chicago, IL 60612 USA
| | - Cynthia I. Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Megan E. Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025 USA
| | - David A. Fiellin
- Yale School of Medicine, Internal Medicine, Program in Addiction Medicine, PO Box 208056, 333 Cedar Street, New Haven, CT 06520-8056 USA
| | - Udi Ghitza
- National Institute on Drug Abuse, National Institutes of Health, National Institute on Drug Abuse Center for Clinical Trials Network, 6001 Executive Blvd, Bethesda, MD 20892 USA
| | - Kathryn Hefner
- Yale School of Medicine, Internal Medicine, Program in Addiction Medicine, PO Box 208056, 333 Cedar Street, New Haven, CT 06520-8056 USA
- The Emmes Company, LLC, National Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating Center, 401 N Washington St, Rockville, MD 20850 USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025 USA
| | - R. Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, & Department of Psychiatry, Harvard Medical School, McLean Hospital, Proctor House 3, 115 Mill St, Belmont, MA 02478 USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA
| | - Sterling M. McPherson
- Washington State University Elson S. Floyd College of Medicine, 412 E. Spokane Falls Blvd., Spokane, WA 99202-2131 USA
| | - Landhing Moran
- National Institute on Drug Abuse, National Institutes of Health, National Institute on Drug Abuse Center for Clinical Trials Network, 6001 Executive Blvd, Bethesda, MD 20892 USA
| | - Larissa J. Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025 USA
| | - Li-Tzy Wu
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3903, Durham, NC 27710 USA
| | - Dikla Shmueli-Blumberg
- The Emmes Company, LLC, National Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating Center, 401 N Washington St, Rockville, MD 20850 USA
| | - Matisyahu Shulman
- Department of Psychiatry, Columbia University Irving Medical Center & Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY USA
| | - Robert P. Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201-5633 USA
| | - Kari A. Stephens
- Departments of Family Medicine, Biomedical Informatics & Medical Education, University of Washington, Seattle, WA 98195 USA
| | | | - John Marsden
- Addictions Department, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, DeCrespigny Park, Denmark Hill, London, SE5 8AF UK
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Tobacco dependence is associated with increased risk for multi-morbid clustering of posttraumatic stress disorder, depressive disorder, and pain among post-9/11 deployed veterans. Psychopharmacology (Berl) 2019; 236:1729-1739. [PMID: 30617565 DOI: 10.1007/s00213-018-5155-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
RATIONALE Tobacco use is highly prevalent among individuals with posttraumatic stress disorder (PTSD), depressive disorders, and pain. Research has revealed pairwise relationships among these conditions but has not examined more complex relationships that may influence symptom severity, chronicity, and treatment outcome. OBJECTIVE To examine the clustering of current PTSD, depressive disorders, and clinically significant pain according to current tobacco use and dependence among post-9/11 deployed veterans. METHODS Logistic regression was used to examine the clustering of these conditions in relationship to current tobacco use/dependence, while adjusting for age and total combat exposure, in 343 post-9/11 deployed veterans enrolled in the Translational Research Center for TBI and Stress Disorders (TRACTS) cohort (Mage = 32.1 + 8.3 years; 38% current tobacco use; 25% low and 12% moderate/high tobacco dependence). RESULTS A three-way clustering of PTSD, depressive disorder, and pain was more likely than any single or pairwise combination of these conditions in moderate/high tobacco-dependent veterans compared to tobacco non-users (adjusted ORs = 3.50 to 4.18). This multi-morbidity cluster also was associated with increased PTSD severity. CONCLUSIONS Moderate to high dependence on tobacco is associated with substantially increased clustering of PTSD, depression, and clinically significant pain in veterans. Research examining synergistic interactions among these conditions, biological vulnerabilities shared among them, and the direct impact of tobacco use on the pathophysiology of PTSD, depression, and pain is needed. The results of such work may spur development of more effective integrated treatments to reduce the negative impact of these multi-morbid conditions on veterans' wellbeing and long-term health.
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Salem BE, Nyamathi Anp A, Reback C, Shoptaw S, Zhang S, Nudelman O. Unmet physical and mental healthcare needs among stimulant-using gay and bisexual homeless men. Issues Ment Health Nurs 2015; 36:685-92. [PMID: 26440871 PMCID: PMC4801108 DOI: 10.3109/01612840.2015.1021938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to gain a greater understanding of predictors of the unmet physical and mental healthcare needs of homeless, stimulant-using, gay and bisexual (G/B) men. This study correlated baseline self-reported unmet physical and mental healthcare needs among stimulant-using homeless G/B men (n = 422, 18-46 years of age). A structured questionnaire was administered at baseline and data were collected from October 2009 to January 2013. The study was approved by the University of California Human Subjects' Protection committee and the Friends Research Institute Human Research Protection Committee. Logistic regression revealed that those who self-reported ever being married, being in fair or poor health and in moderate-to-very severe pain, were more likely to experience unmet needs for physical health care. In terms of unmet mental health needs, those who self-reported moderate-to-very severe pain and/or those reporting having sex while high, were more likely to report unmet needs for mental health care. In contrast, those reporting receiving social support from others were less likely to have an unmet mental healthcare need. Research implications are discussed as they relate to access to healthcare needs among this vulnerable population.
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Affiliation(s)
| | | | - Cathy Reback
- b Friends Research Institute; University of California; Integrated Substance Abuse Programs and Semel Institute for Neuroscience and Human Behavior , Los Angeles , California , USA
| | - Steven Shoptaw
- c University of California , Los Angeles , California , USA
| | - Sheldon Zhang
- d San Diego State University , Los Angeles , California , USA
| | - Olga Nudelman
- a UCLA School of Nursing , Los Angeles , California , USA
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Shmueli-Blumberg D, Hu L, Allen C, Frasketi M, Wu LT, Vanveldhuisen P. The national drug abuse treatment clinical trials network data share project: website design, usage, challenges, and future directions. Clin Trials 2013; 10:977-86. [PMID: 24085772 DOI: 10.1177/1740774513503522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are many benefits of data sharing, including the promotion of new research from effective use of existing data, replication of findings through re-analysis of pooled data files, meta-analysis using individual patient data, and reinforcement of open scientific inquiry. A randomized controlled trial is considered as the 'gold standard' for establishing treatment effectiveness, but clinical trial research is very costly, and sharing data is an opportunity to expand the investment of the clinical trial beyond its original goals at minimal costs. PURPOSE We describe the goals, developments, and usage of the Data Share website (http://www.ctndatashare.org) for the National Drug Abuse Treatment Clinical Trials Network (CTN) in the United States, including lessons learned, limitations, and major revisions, and considerations for future directions to improve data sharing. METHODS Data management and programming procedures were conducted to produce uniform and Health Insurance Portability and Accountability Act (HIPAA)-compliant de-identified research data files from the completed trials of the CTN for archiving, managing, and sharing on the Data Share website. RESULTS Since its inception in 2006 and through October 2012, nearly 1700 downloads from 27 clinical trials have been accessed from the Data Share website, with the use increasing over the years. Individuals from 31 countries have downloaded data from the website, and there have been at least 13 publications derived from analyzing data through the public Data Share website. LIMITATIONS Minimal control over data requests and usage has resulted in little information and lack of control regarding how the data from the website are used. Lack of uniformity in data elements collected across CTN trials has limited cross-study analyses. CONCLUSIONS The Data Share website offers researchers easy access to de-identified data files with the goal to promote additional research and identify new findings from completed CTN studies. To maximize the utility of the website, ongoing collaborative efforts are needed to standardize the core measures used for data collection in the CTN studies with the goal to increase their comparability and to facilitate the ability to pool data files for cross-study analyses.
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