1
|
Baloh J, Charton H, Curran GM. Substance Use Disorder Treatment Programs during a Health Crisis: Response to the COVID-19 Pandemic and Future Implications. Subst Use Misuse 2023; 58:1855-1865. [PMID: 37722809 PMCID: PMC10872742 DOI: 10.1080/10826084.2023.2257305] [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] [Indexed: 09/20/2023]
Abstract
Background: The COVID-19 pandemic rapidly changed how substance use disorder (SUD) treatment services are delivered. In this qualitative study, we examined what changes SUD treatment programs in Arkansas implemented in response to the pandemic, what factors influenced their ability to implement these changes, and their reflections, outlook, and future recommendations. Methods: Between May and August 2020, we conducted semi-structured phone interviews with 29 leaders at 21 SUD programs throughout Arkansas. Interview questions focused on what changes programs implemented in response to the pandemic, barriers and facilitators to implementation, and future outlook. Interviews were thematically analyzed. Results: Programs implemented similar infection control practices, including COVID-19 screening at entry, masks, hand hygiene, and social distancing. Residential programs discontinued outside visitations and capped admissions, and outpatient programs implemented telehealth services. Clients generally responded well to the changes, however many experienced difficulties (e.g., anxiety, lack of access to telehealth). While programs welcomed additional financial support (e.g., CARES act) and looser regulatory restrictions (e.g., telehealth use), many struggled economically due to lower demand and insufficient reimbursement. Programs varied in leadership and staff responses to the pandemic, and in their capacity to implement the changes (e.g., facilities, staffing). Finally, interviewees acknowledged they were unprepared for the pandemic and were uncertain about the future. Conclusions: The insights from the COVID-19 pandemic and SUD programs' responses helps researchers, policymakers and practitioners understand what has happened during the pandemic, how to prepare for future crises, and how to build more resilient SUD and public health systems.
Collapse
Affiliation(s)
- Jure Baloh
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heidi Charton
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Geoffrey M. Curran
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| |
Collapse
|
2
|
Jing F, Li Z, Qiao S, Ning H, Zhou S, Li X. Association between immigrant concentration and mental health service utilization in the United States over time: A geospatial big data analysis. Health Place 2023; 83:103055. [PMID: 37311276 PMCID: PMC10527759 DOI: 10.1016/j.healthplace.2023.103055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
Immigrants (foreign-born United States [US] citizens) generally have lower utilization of mental health services compared with US-born counterparts, but extant studies have not investigated the disparities in mental health service utilization within immigrant population nationwide over time. Leveraging mobile phone-based visitation data, we estimated the average mental health utilization in contiguous US census tracts in 2019, 2020, and 2021 by employing two novel outcomes: mental health service visits and visit-to-need ratio (i.e., visits per depression diagnosis). We then investigated the tract-level association between immigration concentration and mental health service utilization outcomes using mixed-effects linear regression models that accounted for spatial lag effects, time effects, and covariates. This study reveals spatial and temporal disparities in mental health service visits and visit-to-need ratio among different levels of immigrant concentration across the US, both before and during the pandemic. Tracts with higher concentrations of Latin American immigrants showed significantly lower mental health service utilization visits and visit-to-need ratio, particularly in the US West. Tracts with Asian and European immigrant concentrations experienced a more significant decline in mental health service utilization visits and visit-to-need ratio from 2019 to 2020 than those with Latin American concentrations. Meanwhile, in 2021, tracts with Latin American concentrations had the least recovery in mental health service utilization visits. The study highlights the potential of geospatial big data for mental health research and informs public health interventions.
Collapse
Affiliation(s)
- Fengrui Jing
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA.
| | - Zhenlong Li
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
| | - Shan Qiao
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Huan Ning
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
| | - Suhong Zhou
- School of Geography and Planning, Sun Yat-sen University, Guangzhou, 510275, China
| | - Xiaoming Li
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| |
Collapse
|
3
|
Mahoney JJ, Finomore VS, Marton JL, Ramadan J, Hodder SL, Thompson-Lake DGY, Marsh CB, Koch-Gallup N, Ranjan M, Rezai AR. Identifying biomarkers of drug use recurrence using wearable device technologies and phone applications. Drug Alcohol Depend 2023; 249:110817. [PMID: 37331302 PMCID: PMC10416187 DOI: 10.1016/j.drugalcdep.2023.110817] [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: 02/06/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Identifying predictors of drug use recurrence (DUR) is critical to combat the addiction epidemic. Wearable devices and phone-based applications for obtaining self-reported assessments in the patient's natural environment (e.g., ecological momentary assessment; EMA) have been used in various healthcare settings. However, the utility of combining these technologies to predict DUR in substance use disorder (SUD) has not yet been explored. This study investigates the combined use of wearable technologies and EMA as a potential mechanism for identifying physiological/behavioral biomarkers of DUR. METHODS Participants, recruited from an SUD treatment program, were provided with a commercially available wearable device that continuously monitors biometric signals (e.g., heart rate/variability [HR/HRV], sleep characteristics). They were also prompted daily to complete an EMA via phone-based application (EMA-APP) that included questionnaires regarding mood, pain, and craving. RESULTS Seventy-seven participants are included in this pilot study (34 participants experienced a DUR during enrollment). Wearable technologies revealed that physiological markers were significantly elevated in the week prior to DUR relative to periods of sustained abstinence (p<0.001). Results from the EMA-APP revealed that those who experienced a DUR reported greater difficulty concentrating, exposure to triggers associated with substance use, and increased isolation the day prior to DUR (p<0.001). Compliance with study procedures during the DUR week was lower than any other period of measurement (p<0.001). CONCLUSIONS These results suggest that data acquired via wearable technologies and the EMA-APP may serve as a method of predicting near-term DUR, thereby potentially prompting intervention before drug use occurs.
Collapse
Affiliation(s)
- James J Mahoney
- WVU Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA; WVU Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA.
| | - Victor S Finomore
- WVU Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA
| | - Jennifer L Marton
- WVU Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA; WVU Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA
| | - Jad Ramadan
- WVU Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA
| | - Sally L Hodder
- West Virginia Clinical & Translational Science Institute, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Daisy G Y Thompson-Lake
- WVU Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA
| | - Clay B Marsh
- WVU Department of Medicine, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA
| | - Nicolas Koch-Gallup
- WVU Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA
| | - Manish Ranjan
- WVU Department of Neurosurgery, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA
| | - Ali R Rezai
- WVU Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA; WVU Department of Neurosurgery, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, 26506, USA
| |
Collapse
|
4
|
Stein BD, Landis RK, Sheng F, Saloner B, Gordon AJ, Sorbero M, Dick AW. Buprenorphine Treatment Episodes During the First Year of COVID: a Retrospective Examination of Treatment Initiation and Retention. J Gen Intern Med 2023; 38:733-737. [PMID: 36474004 PMCID: PMC9734477 DOI: 10.1007/s11606-022-07891-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND During the COVID pandemic, overall buprenorphine treatment appeared to remain relatively stable, despite some studies suggesting a decrease in patients starting buprenorphine. There is a paucity of empirical information regarding patterns of buprenorphine treatment during the pandemic. OBJECTIVE To better understand the patterns of buprenorphine episodes during the pandemic and how those patterns compared to pre-pandemic patterns. DESIGN Pharmacy claims representing approximately 92% of all prescriptions filled at retail pharmacies in all 50 US states and the District of Columbia. PARTICIPANTS Individuals filling buprenorphine prescriptions indicated for treatment of opioid use disorder. MAIN MEASURES The number of active, starting, and ending buprenorphine treatment episodes March 13 to December 1, 2020, and the expected number of such episodes in 2020 based on the growth in treatment episodes from March 13 to December 1, 2019. KEY RESULTS The observed number of active buprenorphine episodes in December 2020 was comparable to the expected number, but new treatment episodes starting between March 13 and December 1, 2020, were 17.2% fewer than expected based on the 2019 experience. Similarly, the number of episodes that ended between March 13 and December 1, 2020, was 16.0% fewer than expected. Decreases from expected episode starts and ends occurred throughout the period but were greatest in the 2 months after the declaration of the public health emergency. CONCLUSIONS AND RELEVANCE Beneath the apparent stability of buprenorphine patient numbers during the pandemic, the flow of individuals receiving buprenorphine treatment changed substantially. Our findings shed light on how policy changes meant to support buprenorphine prescribing influenced prescribing dynamics during that period, suggesting that while policy efforts may have been successful in maintaining existing patients in treatment, that success did not extend to individuals not yet in treatment.
Collapse
Affiliation(s)
- Bradley D Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA.
| | - Rachel K Landis
- George Washington University Trachtenberg School of Public Policy, Washington, DC, USA.,RAND Corporation, Arlington, VA, USA
| | | | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
| | - Adam J Gordon
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mark Sorbero
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
| | | |
Collapse
|
5
|
Feder KA, Choi J, Schluth CG, Hayashi K, DeBeck K, Milloy MJ, Kirk GD, Mehta SH, Kipke M, Moore RD, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Genberg BL. Factors associated with self-reported avoidance of harm reduction services during the COVID-19 pandemic by people who use drugs in five cities in the United States and Canada. Drug Alcohol Depend 2022; 241:109544. [PMID: 35779987 PMCID: PMC9225925 DOI: 10.1016/j.drugalcdep.2022.109544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study examines individual-level factors associated with avoiding two important health services for people who use drugs-medications for treatment of opioid use disorder and syringe service programs-during the first year of the COVID-19 pandemic. METHODS Data come from two subsamples of people who use drugs who were active participants in one of nine cohort studies in Vancouver, British Columbia; Baltimore, Maryland; Los Angeles, California; Chicago, Illinois; and Miami, Florida. Participants were interviewed remotely about COVID-19-associated disruptions to healthcare. We estimated the association of demographic, social, and health factors with each outcome using logistic regression among 702 participants (medication analysis) and 304 participants (syringe service analysis.) Analyses were repeated, stratified by city of residence, to examine geographic variation in risk. RESULTS There were large differences between cities in the prevalence of avoiding picking up medications for opioid use disorder, with almost no avoidance in Vancouver (3%) and nearly universal avoidance in Los Angeles, Chicago, and Miami (>90%). After accounting for between-city differences, no individual factors were associated with avoiding picking up medications. The only factor significantly associated with avoiding syringe service programs was higher levels of self-reported worry about COVID-19. CONCLUSION During the first year of the COVID-19 pandemic, geographic differences in service and policy contexts likely influenced avoidance of health and harm reduction services by people who use drugs in the United States and Canada more than individual differences between people.
Collapse
Affiliation(s)
- Kenneth A. Feder
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States,Correspondence to: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21211, USA
| | - JinCheol Choi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Catherine G. Schluth
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Michael-John Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada,Division of Social Medicine, Department of Medicine, University of British Columbia, Columbia
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States,Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Michele Kipke
- Keck School of Medicine, University of Southern California, United States
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Marianna K. Baum
- Stemple School of Public Health, Florida International University, United States
| | - Steven Shoptaw
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, USA
| | - Pamina M. Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, USA
| | | | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| |
Collapse
|
6
|
Feder KA, Sun J, Rudolph JE, Cepeda J, Astemborski J, Baker PA, Piggott DA, Kirk GD, Mehta SH, Genberg BL. Mortality by cause of death during year 1 of the COVID-19 pandemic in a cohort of older adults from Baltimore Maryland who have injected drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103842. [PMID: 36067723 PMCID: PMC9395292 DOI: 10.1016/j.drugpo.2022.103842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND In 2020, the first year of the COVID-19 pandemic, overdose deaths increased. However, no studies have characterized changes in mortality during the pandemic in a well-characterized cohort of people who use drugs in active follow-up at the time of pandemic onset. DESIGN We compared all-cause and cause-specific mortality in the first year of the pandemic (Mar-Dec 2020) to the five years preceding (Jan 2015-Feb 2020), among participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-recruited cohort of adults from Baltimore who have injected drugs. 3510 participants contributed 17,498 person-years [py] of follow-up time. Cause and dates of death were ascertained through the National Death Index. Comparisons were made for the full cohort and within subgroups with potentially differential levels of vulnerability. RESULTS All-cause mortality in 2020 was 39.6 per 1000 py, as compared to 37.2 per 1000 py pre- pandemic (Adjusted Incidence Rate Ratio = 1.09, 95%: confidence interval: 0.84-1.41). Increases were mostly attributable to chronic disease deaths; injury/poisoning deaths did not increase. No pre-post differences were statistically significant. CONCLUSION In this exploratory analysis of an older cohort of urban-dwelling adults who have injected drugs, mortality changes during the first year of the pandemic differed from national trends and varied across potentially vulnerable subgroups. More research is needed to understand determinants of increased risk of mortality during the pandemic among subgroups of people who use drugs.
Collapse
Affiliation(s)
- Kenneth A Feder
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, United States.
| | - Jing Sun
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Jacqueline E Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Javier Cepeda
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Jacquie Astemborski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Pieter A Baker
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Damani A Piggott
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States; Department of Medicine, Johns Hopkins University School of Medicine, United States
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States; Department of Medicine, Johns Hopkins University School of Medicine, United States
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, United States
| |
Collapse
|
7
|
Cantor JH, Whaley CM, Stein BD, Powell D. Analysis of Substance Use Disorder Treatment Admissions in the US by Sex and Race and Ethnicity Before and During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2232795. [PMID: 36136336 PMCID: PMC9500559 DOI: 10.1001/jamanetworkopen.2022.32795] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
This cross-sectional study examines the changes in treatment admissions for substance use disorder during the COVID-19 pandemic by sex and race and ethnicity.
Collapse
Affiliation(s)
- Jonathan H. Cantor
- Department of Healthcare Delivery, RAND Corporation, Santa Monica, California
| | | | - Bradley D. Stein
- Department of Healthcare Delivery, RAND Corporation, Pittsburgh, Pennsylvania
| | - David Powell
- Department of Healthcare Delivery, RAND Corporation, Santa Monica, California
| |
Collapse
|
8
|
Abstract
Coronavirus disease 2019 (COVID-19)-related stressors and restrictions, in the absence of social and institutional support, have led many individuals to either increase their substance consumption or relapse. Consequently, treatment programs for substance use disorders (SUDs) made a transition from in-person to remote care delivery. This review discusses the following evidence regarding changes prompted by the COVID pandemic to the clinical care of individuals with SUDs: (1) reduction in availability of care, (2) increase in demand for care, (3) transition to telemedicine use, (4) telemedicine for treatment of opioid use disorders, and (5) considerations for use of telemedicine in treating SUDs.
Collapse
|
9
|
Cantor J, Sood N, Bravata DM, Pera M, Whaley C. The impact of the COVID-19 pandemic and policy response on health care utilization: Evidence from county-level medical claims and cellphone data. JOURNAL OF HEALTH ECONOMICS 2022; 82:102581. [PMID: 35067386 PMCID: PMC8755425 DOI: 10.1016/j.jhealeco.2022.102581] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/29/2021] [Accepted: 01/09/2022] [Indexed: 05/20/2023]
Abstract
The COVID-19 pandemic has forced federal, state, and local policymakers to respond by legislating, enacting, and enforcing social distancing policies. However, the impact of these policies on healthcare utilization in the United States has been largely unexplored. We examine the impact of county-level shelter in place ordinances on healthcare utilization using two unique datasets-employer-sponsored insurance for over 6 million people in the US and cell phone location data. We find that introduction of these policies was associated with reductions in the use of preventive care, elective care, and the number of weekly visits to physician offices, hospitals and other health care-related industries. However, controlling for county-level exposure to the COVID-19 pandemic as a way to account for the endogenous nature of policy implementation reduces the impact of these policies. Our results imply that while social distancing policies do lead to reductions in healthcare utilization, much of these reductions would have occurred even in the absence of these policies.
Collapse
Affiliation(s)
| | - Neeraj Sood
- University of Southern California, Los Angeles, CA, USA; National Bureau for Economic Research, Cambridge, MA, USA
| | - Dena M Bravata
- Castlight Health, San Francisco, CA, USA; Center for Primary Care and Outcomes Research, Stanford, CA, USA
| | - Megan Pera
- Castlight Health, San Francisco, CA, USA
| | | |
Collapse
|