1
|
Saunders EC, Budney AJ, Cavazos-Rehg P, Scherer E, Bell K, John D, Marsch LA. Evaluating preferences for medication formulation and treatment model among people who use opioids non-medically: A web-based cross-sectional study. J Subst Use Addict Treat 2024:209383. [PMID: 38670531 DOI: 10.1016/j.josat.2024.209383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 02/19/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Over the past decade, treatment for opioid use disorder has expanded to include long-acting injectable and implantable formulations of medication for opioid use disorder (MOUD), and integrated treatment models systematically addressing both behavioral and physical health. Patient preference for these treatment options has been underexplored. Gathering data on OUD treatment preferences is critical to guide the development of patient-centered treatment for OUD. This cross-sectional study assessed preferences for long-acting MOUD and integrated treatment using an online survey. METHODS An online Qualtrics survey assessed preferences for MOUD formulation and integrated treatment models. The study recruited participants (n = 851) in October and November 2019 through advertisements or posts on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (mTurk). Eligible participants scored a two or higher on the opioid pain reliever or heroin scales of the Tobacco, Alcohol Prescription Medication and other Substance Use (TAPS) Tool. Structured survey items obtained patient preference for MOUD formulation and treatment model. Using stated preference methods, the study assessed preference via comparison of preferred options for MOUD and treatment model. RESULTS In the past year, 824 (96.8 %) participants reported non-prescribed use of opioid pain relievers (mean TAPS score = 2.72, SD = 0.46) and 552 (64.9 %) reported heroin or fentanyl use (mean TAPS score = 2.73, SD = 0.51). Seventy-four percent of participants (n = 631) reported currently or previously receiving OUD treatment, with 407 (48.4 %) receiving MOUD. When asked about preferences for type of MOUD formulation, 452 (53.1 %) preferred a daily oral formulation, 115 (13.5 %) preferred an implant, 114 (13.4 %) preferred a monthly injection and 95 (11.2 %) preferred a weekly injection. Approximately 8.8 % (n = 75) would not consider MOUD regardless of formulation. The majority of participants (65.2 %, n = 555) preferred receiving treatment in a specialized substance use treatment program distinct from their medical care, compared with receiving care in an integrated model (n = 296, 34.8 %). CONCLUSIONS Though most participants expressed willingness to try long-acting MOUD formulations, the majority preferred short-acting formulations. Likewise, the majority preferred non-integrated treatment in specialty substance use settings. Reasons for these preferences provide insight on developing effective educational tools for patients and suggesting targets for intervention to develop a more acceptable treatment system.
Collapse
Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| |
Collapse
|
2
|
Schlieter H, Gand K, Marsch LA, Chan WS, Kowatsch T. Editorial: Scaling-up health-IT-sustainable digital health implementation and diffusion. Front Digit Health 2024; 6:1296495. [PMID: 38686176 PMCID: PMC11056544 DOI: 10.3389/fdgth.2024.1296495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Hannes Schlieter
- Research Group Digital Health, Technische Universität Dresden, Dresden, Germany
| | - Kai Gand
- Research Group Digital Health, Technische Universität Dresden, Dresden, Germany
| | - Lisa A. Marsch
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | - Wai Sze Chan
- Department of Psychology, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
McLeman B, Gauthier P, Lester LS, Homsted F, Gardner V, Moore SK, Joudrey PJ, Saldana L, Cochran G, Harris JP, Hefner K, Chongsi E, Kramer K, Vena A, Ottesen RA, Gallant T, Boggis JS, Rao D, Page M, Cox N, Iandiorio M, Ambaah E, Ghitza U, Fiellin DA, Marsch LA. Implementing a pharmacist-integrated collaborative model of medication treatment for opioid use disorder in primary care: study design and methodological considerations. Addict Sci Clin Pract 2024; 19:18. [PMID: 38500166 PMCID: PMC10949656 DOI: 10.1186/s13722-024-00452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Pharmacists remain an underutilized resource in the treatment of opioid use disorder (OUD). Although studies have engaged pharmacists in dispensing medications for OUD (MOUD), few studies have evaluated collaborative care models in which pharmacists are an active, integrated part of a primary care team offering OUD care. METHODS This study seeks to implement a pharmacist integrated MOUD clinical model (called PrIMO) and evaluate its feasibility, acceptability, and impact across four diverse primary care sites. The Consolidated Framework for Implementation Research is used as an organizing framework for study development and interpretation of findings. Implementation Facilitation is used to support PrIMO adoption. We assess the primary outcome, the feasibility of implementing PrIMO, using the Stages of Implementation Completion (SIC). We evaluate the acceptability and impact of the PrIMO model at the sites using mixed-methods and combine survey and interview data from providers, pharmacists, pharmacy technicians, administrators, and patients receiving MOUD at the primary care sites with patient electronic health record data. We hypothesize that it is feasible to launch delivery of the PrIMO model (reach SIC Stage 6), and that it is acceptable, will positively impact patient outcomes 1 year post model launch (e.g., increased MOUD treatment retention, medication regimen adherence, service utilization for co-morbid conditions, and decreased substance use), and will increase each site's capacity to care for patients with MOUD (e.g., increased number of patients, number of prescribers, and rate of patients per prescriber). DISCUSSION This study will provide data on a pharmacist-integrated collaborative model of care for the treatment of OUD that may be feasible, acceptable to both site staff and patients and may favorably impact patients' access to MOUD and treatment outcomes. TRIAL REGISTRATION The study was registered on Clinicaltrials.gov (NCT05310786) on April 5, 2022, https://www. CLINICALTRIALS gov/study/NCT05310786?id=NCT05310786&rank=1.
Collapse
Affiliation(s)
- Bethany McLeman
- Northeast Node, NIDA Drug Abuse Treatment Clinical Trials Network, Hanover, NH, USA.
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
| | - Phoebe Gauthier
- Northeast Node, NIDA Drug Abuse Treatment Clinical Trials Network, Hanover, NH, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Laurie S Lester
- Northeast Node, NIDA Drug Abuse Treatment Clinical Trials Network, Hanover, NH, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | | | - Vernon Gardner
- Northeast Node, NIDA Drug Abuse Treatment Clinical Trials Network, Hanover, NH, USA
| | - Sarah K Moore
- Northeast Node, NIDA Drug Abuse Treatment Clinical Trials Network, Hanover, NH, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Paul J Joudrey
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa Saldana
- Lighthouse Institute, Chestnut Health Systems, Eugene, OR, USA
| | - Gerald Cochran
- University of Utah, Salt Lake City, UT, USA
- Greater Intermountain Node, NIDA Drug Abuse Treatment Clinical Trials Network, Salt Lake City, UT, USA
| | | | | | | | | | | | | | - Tess Gallant
- Northeast Node, NIDA Drug Abuse Treatment Clinical Trials Network, Hanover, NH, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Jesse S Boggis
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Deepika Rao
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | | | - Nicholas Cox
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | | | - Ekow Ambaah
- Harbor Care Health & Wellness, Nashua, NH, USA
| | - Udi Ghitza
- National Institute on Drug Abuse, North Bethesda, MD, USA
| | - David A Fiellin
- New England Consortium Node, NIDA Drug Abuse Treatment Clinical Trials Network, New Haven, CT, USA
- Program in Addiction Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lisa A Marsch
- Northeast Node, NIDA Drug Abuse Treatment Clinical Trials Network, Hanover, NH, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| |
Collapse
|
4
|
Fishman M, Wenzel K, Gauthier P, Borodovsky J, Murray O, Subramaniam G, Levy S, Fredyma E, McLeman B, Marsch LA. Engagement, initiation, and retention in medication treatment for opioid use disorder among young adults: A narrative review of challenges and opportunities. J Subst Use Addict Treat 2024:209352. [PMID: 38494051 DOI: 10.1016/j.josat.2024.209352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Opioid Use Disorder (OUD) is a catastrophic public health problem for young adults (YAs) and their families. While medication for OUD (MOUD) is safe, effective, and recognized as the standard of care, its' uptake and success have been limited in YAs compared to older adults. METHODS This narrative review summarizes the existing literature and highlights select studies regarding barriers to YA MOUD, potential explanations for those barriers, and strategies to overcome them. RESULTS Barriers are prominent along the entire cascade of care, including: treatment engagement and entry, MOUD initiation, and MOUD retention. Hypothesized explanations for barriers include: developmental vulnerability, inadequate treatment system capacity, stigma against MOUD, among others. Interventions to address barriers include: promotion of family involvement, increasing provider capacity, integration of MOUD into primary care, assertive outreach, and others. CONCLUSIONS Integrating an adapted version of family coaching from the Community Reinforcement Approach and Family Training (CRAFT) and other models into YA MOUD treatment serves as an example of an emerging novel practice that holds promise for broadening the funnel of engagement in treatment and initiation of MOUD, and enhancing treatment outcomes. This and other developmentally-informed approaches should be evaluated as part of a high-priority clinical and research agenda for improving OUD treatment for YAs.
Collapse
Affiliation(s)
- Marc Fishman
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA; Johns Hopkins University School of Medicine, Dept of Psychiatry, 3800 Frederick Avenue, Baltimore, MD 21229, USA.
| | - Kevin Wenzel
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA
| | - Phoebe Gauthier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Owen Murray
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Geetha Subramaniam
- Center for Clinical Trials Network, National Institute on Drug Abuse, 301 North Stonestreet Ave, Bethesda, MD 20892, USA
| | - Sharon Levy
- Boston Children's Hospital, Division of Addiction Medicine, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Emma Fredyma
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| |
Collapse
|
5
|
Young A, Sinicrope P, Kelpin S, Roche AI, Sabaque C, Pham C, Marsch LA, Campbell ANC, Venner K, Bastian E, Nord T, Mason G, Baker L, Wyatt T, Fish A, Bart G, Patten CA. Wiidookaage'Win: A Community-Based Qualitative Approach to Developing a Facebook Group Intervention for Native Women to Support Recovery From Opioid Use. Am J Health Promot 2024; 38:205-218. [PMID: 37955409 PMCID: PMC10859867 DOI: 10.1177/08901171231205355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
PURPOSE To develop a culturally-tailored American Indian/Alaska Native (AI/AN) women's Facebook group supporting opioid recovery as an adjunct to medication. DESIGN Community-based, qualitative approach. SETTING Minnesota, U.S. PARTICIPANTS AI/AN women in opioid recovery, interested parties, and a Community Advisory Committee (CAC) of AI/AN women with lived experience, health care providers, and community members. INTERVENTION We developed evidence-based content focusing on stress/trauma and substance use, mindfulness, responding to triggers, and supportive community resources. Additional content centered on AI/AN culture was also selected. METHOD Interviews were conducted by two women, then transcribed and coded using content analysis with NVivo software. Results were presented to CAC for further content refinement. RESULTS CAC members (n = 10) guided study methods, intervention development, and dissemination activities. 14 AI/AN women (mean age 36.4 years; mean 6.7 months opioid abstinence) and 12 interested parties (7 men, 5 women) were receptive to an AI/AN gender-specific Facebook group, preferring content with AI/AN people and/or text resonating with AI/AN culture (e.g., Native traditions, family, personal stories, historical trauma). Recommendations included (1) protect confidentiality, (2) retain positivity, (3) incorporate resources and exercises to build coping skills, and (4) moderators should be authentic and relatable to build trust. CONCLUSIONS Our approach provides a model for developing culturally tailored, appealing and effective social media interventions to support AI/AN women in recovery from opioid use disorder.
Collapse
Affiliation(s)
- Antonia Young
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Pamela Sinicrope
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Sydney Kelpin
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Anne I. Roche
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Corinna Sabaque
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Cuong Pham
- Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Aimee N. C. Campbell
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, USA
| | - Kamilla Venner
- Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, NM, USA
| | | | - Teresa Nord
- ICWA Law Center, American Indian Prison Project, Minneapolis, MN, USA
| | - Gail Mason
- Native American Community Clinic, Minneapolis, MN, USA
| | - Laiel Baker
- Counseling and Recovery Services, Indian Health Board of Minneapolis, Inc, Minneapolis, MN, USA
| | - Thomas Wyatt
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Amy Fish
- Minnesota Indian Women’s Resource Center, Minneapolis, MN, USA
| | - Gavin Bart
- Hennepin Healthcare, Minneapolis, MN, USA
| | - Christi A. Patten
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
6
|
Ober AJ, Dopp AR, Clingan SE, Curtis ME, Lin C, Calhoun S, Larkins S, Black M, Hanano M, Osterhage KP, Baldwin LM, Saxon AJ, Hichborn EG, Marsch LA, Mooney LJ, Hser YI. Stakeholder perspectives on a telemedicine referral and coordination model to expand medication treatment for opioid use disorder in rural primary care clinics. J Subst Use Addict Treat 2024; 156:209194. [PMID: 37863356 DOI: 10.1016/j.josat.2023.209194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/11/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Opioid overdose deaths are increasing rapidly in the United States. Medications for opioid use disorder (MOUD) are effective and can be delivered in primary care, but uptake has been limited in rural communities. Referral to and coordination with an external telemedicine (TM) vendor by rural primary care clinics for MOUD (TM-MOUD) may increase MOUD access for rural patients, but we know little about perspectives on this model among key stakeholders. As part of a TM-MOUD feasibility study, we explored TM-MOUD acceptability and feasibility among personnel and patients from seven rural primary care clinics and a TM-MOUD vendor. METHODS We conducted virtual interviews or focus groups with clinic administrators (n = 7 interviews), clinic primary care and behavioral health providers (8 groups, n = 30), other clinic staff (9 groups, n = 37), patients receiving MOUD (n = 16 interviews), TM-MOUD vendor staff (n = 4 interviews), and vendor-affiliated behavioral health and prescribing providers (n = 17 interviews). We asked about experiences with and acceptability of MOUD (primarily buprenorphine) and telemedicine (TM) and a TM-MOUD referral and coordination model. We conducted content analysis to identify themes and participants quantitatively rated acceptability of TM-MOUD elements on a 4-item scale. RESULTS Perceived benefits of vendor-based TM-MOUD included reduced logistical barriers, more privacy and less stigma, and access to services not available locally (e.g., counseling, pain management). Barriers included lack of internet or poor connectivity in patients' homes, limited communication and trust between TM-MOUD and clinic providers, and questions about the value to the clinic of TM-MOUD referral to external vendor. Acceptability ratings for TM-MOUD were generally high; they were lowest among frontline staff. CONCLUSIONS Rural primary care clinic personnel, TM-MOUD vendor personnel, and patients generally perceived referral from primary care to a TM-MOUD vendor to hold potential for increasing access to MOUD in rural communities. Increasing TM-MOUD uptake requires buy-in and understanding among staff of the TM-MOUD workflow, TM services offered, requirements for patients, advantages over clinic-based or TM services from clinic providers, and identification of appropriate patients. Poverty, along with patient hesitation to initiate treatment, creates substantial barriers to MOUD treatment generally; insufficient internet availability creates a substantial barrier to TM-MOUD.
Collapse
Affiliation(s)
| | | | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Megan E Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, CA, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Sherry Larkins
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Megan Black
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Maria Hanano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Katie P Osterhage
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Emily G Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| |
Collapse
|
7
|
Campbell ANC, Rieckmann T, Pavlicova M, Choo TH, Molina K, McDonell M, West AE, Daw R, Marsch LA, Venner KL. Culturally tailored digital therapeutic for substance use disorders with urban Indigenous people in the United States: A randomized controlled study. J Subst Use Addict Treat 2023; 155:209159. [PMID: 37690525 PMCID: PMC10872747 DOI: 10.1016/j.josat.2023.209159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Indigenous people experience health disparities, including higher rates of substance use disorders (SUDs). Digital therapeutics are a growing platform for treatment services and have the potential to expand access to culturally responsive interventions for Indigenous people. As one of the first randomized controlled trials for SUDs for American Indian and Alaska Native (AI/AN) adults, the aim of this study was to pilot test the efficacy of a culturally tailored intervention among urban Indigenous adults. METHODS The study used a randomized controlled parallel design of 12 weeks of treatment-as-usual (TAU) (n = 26) versus TAU + Therapeutic Education System-Native Version (TES-NAV) (n = 27) with follow-up assessments at end of treatment and week 24 in an urban outpatient addiction treatment program for Native American adults. TAU consisted of individual/group counseling and cultural activities. The TES-NAV arm comprised TAU + 26 self-directed culturally tailored digital skills-based modules grounded in the community reinforcement approach with contingency management for abstinence and module completion. Primary outcome was longest consecutive weeks of abstinence from drugs and heavy drinking measured using self-report (Timeline Followback) and urine alcohol and drug toxicology screen during 12 weeks of treatment. Secondary outcomes were percent days abstinence during and posttreatment, coping strategies, social connectedness, and substance use and sexual risk behaviors. RESULTS The study enrolled fifty-three (52.8 % male) AI/AN adults seeking treatment for a SUD. Although the study did not detect a benefit of TAU+TES-NAV over TAU on the primary outcome (Median = 2 consecutive weeks of abstinence for both arms) at end of treatment (treatment effect: Z = -0.78, p = 0.437), TAU+TES-NAV participants did demonstrate significantly greater percent days of abstinence at the week 24 follow-up (69.3 % versus 49.0 % for TAU; t = 2.08, p = 0.045) and significantly greater change in social connectedness mean score, baseline to week 12 (Z = -2.66, p = 0.011), compared to TAU. The study detected no differences between treatment arms for coping strategies or risk behaviors. CONCLUSION The addition of TES-NAV to TAU did not significantly improve consecutive weeks of abstinence from drugs or heavy drinking; however, several secondary findings suggest promise for a culturally tailored digital therapeutic SUD intervention among urban Indigenous people. CLINICAL TRIALS GOV REGISTRATION: #NCT03363256.
Collapse
Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA.
| | - Traci Rieckmann
- School of Medicine, Oregon Health & Science University, 3015 NE 44th Ave, Portland, OR 97213, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St, 6th floor, Room 635, New York, NY 10032, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA
| | - Kelly Molina
- Native American Rehabilitation Association of the Northwest, Inc., 1631 SW Columbia St, Portland, OR 97201, USA
| | - Michael McDonell
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA 99202, USA
| | - Amy E West
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4640 W. Sunset Blvd, Los Angeles, CA 90027, USA
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Kamilla L Venner
- Department of Psychology and Center on Alcohol Substance use & Addiction (CASAA), University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA
| |
Collapse
|
8
|
Bissett PG, Eisenberg IW, Shim S, Rios JAH, Jones HM, Hagen MP, Enkavi AZ, Li JK, Mumford JA, MacKinnon DP, Marsch LA, Poldrack RA. Cognitive tasks, anatomical MRI, and functional MRI data evaluating the construct of self-regulation. bioRxiv 2023:2023.09.27.559869. [PMID: 37808748 PMCID: PMC10557703 DOI: 10.1101/2023.09.27.559869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
We describe the following shared data from N=103 healthy adults who completed a broad set cognitive tasks, surveys, and neuroimaging measurements to examine the construct of self-regulation. The neuroimaging acquisition involved task-based fMRI, resting fMRI, and structural MRI. Each subject completed the following ten tasks in the scanner across two 90-minute scanning sessions: attention network test (ANT), cued task switching, Columbia card task, dot pattern expectancy (DPX), delay discounting, simple and motor selective stop signal, Stroop, a towers task, and a set of survey questions. Subjects also completed resting state scans. The dataset is shared openly through the OpenNeuro project, and the dataset is formatted according to the Brain Imaging Data Structure (BIDS) standard.
Collapse
Affiliation(s)
| | | | - Sunjae Shim
- Department of Psychology, Stanford University
| | | | | | | | - A. Zeynep Enkavi
- Division of the Humanities and Social Sciences, California Institute of Technology
| | - Jamie K. Li
- Department of Psychology, Stanford University
| | | | | | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College
| | | |
Collapse
|
9
|
Park S, Cubillos L, Martinez-Camblor P, Bartels SM, Torrey WC, John DT, Cepeda M, Bell K, Castro S, Suárez-Obando F, Uribe-Restrepo JM, Gómez-Restrepo C, Marsch LA. Integrating Depression and Alcohol Use Care Into Primary Care in Low- and Middle-Income Countries: A Meta-Analysis. Psychiatr Serv 2023; 74:950-962. [PMID: 36852551 DOI: 10.1176/appi.ps.20220267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Evaluation of the effectiveness of integration of depression and alcohol use disorder care into primary health care in low- and middle-income countries (LMICs) is limited. The authors aimed to quantify the effectiveness of integrating mental health care into primary care by examining depression and alcohol use disorder outcomes. The study updates a previous systematic review summarizing research on care integration in LMICs. METHODS Following PRISMA guidelines, the authors included studies from the previous review and studies published from 2017 to 2020 that included adults with alcohol use disorder or depression. Studies were evaluated for type of integration model with the typology developed previously. A meta-analysis using a random-effects model to assess effectiveness of integrated interventions was conducted. Meta-regression analyses to examine the impact of study characteristics on depression and alcohol use disorder outcomes were conducted. RESULTS In total, 49 new articles were identified, and 74 articles from the previous and current studies met inclusion criteria for the meta-analysis. Overall random effect sizes were 0.28 (95% CI=0.22-0.35) and 0.17 (95% CI=0.11-0.24) for studies targeting care integration for depression or for alcohol use disorder, respectively, into primary care in LMICs. High heterogeneity within and among studies was observed. No significant association was found between country income level and depression and alcohol use outcomes. However, differences in effect sizes between types of integration model were statistically significant (p<0.001). CONCLUSIONS Integration of mental health care into primary health care in LMICs was found to improve depression and alcohol use disorder outcomes. This evidence should be considered when designing interventions to improve mental health screening and treatment in LMICs.
Collapse
Affiliation(s)
- Sena Park
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martinez-Camblor
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sophia M Bartels
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - William C Torrey
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Deepak T John
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Kathleen Bell
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Castro
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José Miguel Uribe-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lisa A Marsch
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
10
|
McCormack RP, Rotrosen J, Gauthier P, D'Onofrio G, Fiellin DA, Marsch LA, Novo P, Liu D, Edelman EJ, Farkas S, Matthews AG, Mulatya C, Salazar D, Wolff J, Knight R, Goodman W, Williams J, Hawk K. Implementing Programs to Initiate Buprenorphine for Opioid Use Disorder Treatment in High-Need, Low-Resource Emergency Departments: A Nonrandomized Controlled Trial. Ann Emerg Med 2023; 82:272-287. [PMID: 37140493 PMCID: PMC10524047 DOI: 10.1016/j.annemergmed.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 05/05/2023]
Abstract
STUDY OBJECTIVE We hypothesized that implementation facilitation would enable us to rapidly and effectively implement emergency department (ED)-initiated buprenorphine programs in rural and urban settings with high-need, limited resources and dissimilar staffing structures. METHODS This multicenter implementation study employed implementation facilitation using a participatory action research approach to develop, introduce, and refine site-specific clinical protocols for ED-initiated buprenorphine and referral in 3 EDs not previously initiating buprenorphine. We assessed feasibility, acceptability, and effectiveness by triangulating mixed-methods formative evaluation data (focus groups/interviews and pre/post surveys involving staff, patients, and stakeholders), patients' medical records, and 30-day outcomes from a purposive sample of 40 buprenorphine-receiving patient-participants who met research eligibility criteria (English-speaking, medically stable, locator information, nonprisoners). We estimated the primary implementation outcome (proportion receiving ED-initiated buprenorphine among candidates) and the main secondary outcome (30-day treatment engagement) using Bayesian methods. RESULTS Within 3 months of initiating the implementation facilitation activities, each site implemented buprenorphine programs. During the 6-month programmatic evaluation, there were 134 ED-buprenorphine candidates among 2,522 encounters involving opioid use. A total of 52 (41.6%) practitioners initiated buprenorphine administration to 112 (85.1%; 95% confidence interval [CI] 79.7% to 90.4%) unique patients. Among 40 enrolled patient-participants, 49.0% (35.6% to 62.5%) were engaged in addiction treatment 30 days later (confirmed); 26 (68.4%) reported attending one or more treatment visits; there was a 4-fold decrease in self-reported overdose events (odds ratio [OR] 4.03; 95% CI 1.27 to 12.75). The ED clinician readiness increased by a median of 5.02 (95% CI: 3.56 to 6.47) from 1.92/10 to 6.95/10 (n(pre)=80, n(post)=83). CONCLUSIONS The implementation facilitation enabled us to effectively implement ED-based buprenorphine programs across heterogeneous ED settings rapidly, which was associated with promising implementation and exploratory patient-level outcomes.
Collapse
Affiliation(s)
| | - John Rotrosen
- New York University Grossman School of Medicine, New York, NY
| | | | - Gail D'Onofrio
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT; Yale School of Medicine, Department of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT
| | - David A Fiellin
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT; Yale School of Medicine, Department of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT
| | - Lisa A Marsch
- Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Patricia Novo
- New York University Grossman School of Medicine, New York, NY
| | - David Liu
- National Institute on Drug Abuse, Rockville, MD
| | - E Jennifer Edelman
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT; Yale School of Medicine, Department of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT
| | - Sarah Farkas
- New York University Grossman School of Medicine, New York, NY
| | | | | | | | | | | | | | | | - Kathryn Hawk
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT
| |
Collapse
|
11
|
Hser YI, Mooney LJ, Baldwin LM, Ober A, Marsch LA, Sherman S, Matthews A, Clingan S, Fei Z, Zhu Y, Dopp A, Curtis ME, Osterhage KP, Hichborn EG, Lin C, Black M, Calhoun S, Holtzer CC, Nesin N, Bouchard D, Ledgerwood M, Gehring MA, Liu Y, Ha NA, Murphy SM, Hanano M, Saxon AJ. Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study. J Rural Health 2023; 39:780-788. [PMID: 37074350 PMCID: PMC10718290 DOI: 10.1111/jrh.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE The use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM-delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings. METHODS The study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID-19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre-/post-intervention design (N = 6) was used to assess the clinic-level outcome as patient-days on MOUD based on patient electronic health records. FINDINGS All clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient-days on MOUD during the intervention period compared to the 6-month period before the intervention (mean increase per 1,000 patients: 132 days, P = .08, Cohen's d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period. CONCLUSIONS To expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity.
Collapse
Affiliation(s)
- Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Larissa J. Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Seth Sherman
- Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA
| | - Abigail Matthews
- Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA
| | - Sarah Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Zhe Fei
- Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Alex Dopp
- RAND Corporation, Santa Monica, California, USA
| | - Megan E. Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Katie P. Osterhage
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Emily G. Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California, USA
| | - Megan Black
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | | | - Noah Nesin
- Penobscot Community Health Care, Bangor, Maine, USA
| | | | - Maja Ledgerwood
- Rural Social Service Solutions, LLC, New Meadows, Idaho, USA
| | | | - Yanping Liu
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - Neul Ah Ha
- Clinical Coordinating Center, Emmes Company, Rockville, Maryland, USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
| | - Maria Hanano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Andrew J. Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
12
|
Campbell CI, Chen CH, Adams SR, Asyyed A, Athale NR, Does MB, Hassanpour S, Hichborn E, Jackson-Morris M, Jacobson NC, Jones HK, Kotz D, Lambert-Harris CA, Li Z, McLeman B, Mishra V, Stanger C, Subramaniam G, Wu W, Zegers C, Marsch LA. Patient Engagement in a Multimodal Digital Phenotyping Study of Opioid Use Disorder. J Med Internet Res 2023; 25:e45556. [PMID: 37310787 DOI: 10.2196/45556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD. OBJECTIVE The aim is to examine patient engagement with multiple digital phenotyping methods among patients receiving buprenorphine medication for OUD. METHODS The study enrolled 65 patients receiving buprenorphine for OUD between June 2020 and January 2021 from 4 addiction medicine programs in an integrated health care delivery system in Northern California. Ecological momentary assessment (EMA), sensor data, and social media data were collected by smartphone, smartwatch, and social media platforms over a 12-week period. Primary engagement outcomes were meeting measures of minimum phone carry (≥8 hours per day) and watch wear (≥18 hours per day) criteria, EMA response rates, social media consent rate, and data sparsity. Descriptive analyses, bivariate, and trend tests were performed. RESULTS The participants' average age was 37 years, 47% of them were female, and 71% of them were White. On average, participants met phone carrying criteria on 94% of study days, met watch wearing criteria on 74% of days, and wore the watch to sleep on 77% of days. The mean EMA response rate was 70%, declining from 83% to 56% from week 1 to week 12. Among participants with social media accounts, 88% of them consented to providing data; of them, 55% of Facebook, 54% of Instagram, and 57% of Twitter participants provided data. The amount of social media data available varied widely across participants. No differences by age, sex, race, or ethnicity were observed for any outcomes. CONCLUSIONS To our knowledge, this is the first study to capture these 3 digital data sources in this clinical population. Our findings demonstrate that patients receiving buprenorphine treatment for OUD had generally high engagement with multiple digital phenotyping data sources, but this was more limited for the social media data. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3389/fpsyt.2022.871916.
Collapse
Affiliation(s)
- Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States
| | - Ching-Hua Chen
- Center for Computational Health, IBM Research, Yorktown Heights, NY, United States
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Asma Asyyed
- Addiction Medicine and Recovery Services, The Permanente Medical Group Northern California, Oakland, CA, United States
| | - Ninad R Athale
- Addiction Medicine and Recovery Services, The Permanente Medical Group Northern California, Vallejo, CA, United States
| | - Monique B Does
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Saeed Hassanpour
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Emily Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Heather K Jones
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - David Kotz
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Chantal A Lambert-Harris
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Zhiguo Li
- Center for Computational Health, IBM Research, Yorktown Heights, NY, United States
- Profit Intelligence, Amazon.com, Seattle, WA, United States
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Varun Mishra
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
- Department of Health Sciences, Northeastern University, Boston, MA, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Geetha Subramaniam
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Weiyi Wu
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Christopher Zegers
- Addiction Medicine and Recovery Services, The Permanente Medical Group Northern California, Sacramento, CA, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
13
|
Murray OB, Doyle M, McLeman BM, Marsch LA, Saunders EC, Cox KM, Watts D, Ryer J. Augmenting project ECHO for opioid use disorder with data-informed quality improvement. Addict Sci Clin Pract 2023; 18:24. [PMID: 37106399 PMCID: PMC10139906 DOI: 10.1186/s13722-023-00381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND National opioid-related overdose fatalities totaled 650,000 from 1999 to 2021. Some of the highest rates occurred in New Hampshire, where 40% of the population lives rurally. Medications for opioid use disorder (MOUD; methadone, buprenorphine, and naltrexone) have demonstrated effectiveness in reducing opioid overdose and mortality. Methadone access barriers disproportionally impact rural areas and naltrexone uptake has been limited. Buprenorphine availability has increased and relaxed regulations reduces barriers in general medical settings common in rural areas. Barriers to prescribing buprenorphine include lack of confidence, inadequate training, and lack of access to experts. To address these barriers, learning collaboratives have trained clinics on best-practice performance data collection to inform quality improvement (QI). This project sought to explore the feasibility of training clinics to collect performance data and initiate QI alongside clinics' participation in a Project ECHO virtual collaborative for buprenorphine providers. METHODS Eighteen New Hampshire clinics participating in a Project ECHO were offered a supplemental project exploring the feasibility of performance data collection to inform QI targeting increased alignment with best practice. Feasibility was assessed descriptively, through each clinic's participation in training sessions, data collection, and QI initiatives. An end-of-project survey was conducted to understand clinic staff perceptions of how useful and acceptable they found the program. RESULTS Five of the eighteen health care clinics that participated in the Project ECHO joined the training project, four of which served rural communities in New Hampshire. All five clinics met the criteria for engagement, as each clinic attended at least one training session, submitted at least one month of performance data, and completed at least one QI initiative. Survey results showed that while clinic staff perceived the training and data collection to be useful, there were several barriers to collecting the data, including lack of staff time, and difficulty standardizing documentation within the clinic electronic health record. CONCLUSIONS Results suggest that training clinics to monitor their performance and base QI initiatives on data has potential to impact clinical best practice. While data collection was inconsistent, clinics completed several data-informed QI initiatives, indicating that smaller scale data collection might be more attainable.
Collapse
Affiliation(s)
- Owen B Murray
- Northeast Node of the Clinical Trials Network, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, NH, 03766, Lebanon, USA.
| | - Marcy Doyle
- New Hampshire Citizen's Health Initiative, Institute for Health Policy and Practice, University of New Hampshire, 2 White Street, NH, 03301, Concord, USA
| | - Bethany M McLeman
- Northeast Node of the Clinical Trials Network, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, NH, 03766, Lebanon, USA
| | - Lisa A Marsch
- Northeast Node of the Clinical Trials Network, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, NH, 03766, Lebanon, USA
| | - Elizabeth C Saunders
- Northeast Node of the Clinical Trials Network, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, NH, 03766, Lebanon, USA
| | - Katherine M Cox
- New Hampshire Citizen's Health Initiative, Institute for Health Policy and Practice, University of New Hampshire, 2 White Street, NH, 03301, Concord, USA
| | - Delitha Watts
- New Hampshire Citizen's Health Initiative, Institute for Health Policy and Practice, University of New Hampshire, 2 White Street, NH, 03301, Concord, USA
| | - Jeanne Ryer
- New Hampshire Citizen's Health Initiative, Institute for Health Policy and Practice, University of New Hampshire, 2 White Street, NH, 03301, Concord, USA
| |
Collapse
|
14
|
Saunders EC, Satcher MF, Monico LB, McDonald RD, Springer SA, Farabee D, Gryczynski J, Nyaku A, Reeves D, Kunkel LE, Schultheis AM, Schwartz RP, Lee JD, Marsch LA, Waddell EN. The impact of COVID-19 on the treatment of opioid use disorder in carceral facilities: a cross-sectional study. Health Justice 2022; 10:35. [PMID: 36529829 PMCID: PMC9760540 DOI: 10.1186/s40352-022-00199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
While the COVID-19 pandemic disrupted healthcare delivery everywhere, persons with carceral system involvement and opioid use disorder (OUD) were disproportionately impacted and vulnerable to severe COVID-associated illness. Carceral settings and community treatment programs (CTPs) rapidly developed protocols to sustain healthcare delivery while reducing risk of COVID-19 transmission. This survey study assessed changes to OUD treatment, telemedicine use, and re-entry support services among carceral and CTPs participating in the National Institute on Drug Abuse (NIDA)-funded study, Long-Acting Buprenorphine vs. Naltrexone Opioid Treatments in Criminal Justice System-Involved Adults (EXIT-CJS) study. In December 2020, carceral sites (n = 6; median pre-COVID 2020 monthly census = 3468 people) and CTPs (n = 7; median pre-COVID 2020 monthly census = 550 patients) participating in EXIT-CJS completed a cross-sectional web-based survey. The survey assessed changes pre- (January-March 2020) and post- (April-September 2020) COVID-19 in OUD treatment, telemedicine use, re-entry supports and referral practices. Compared to January-March 2020, half of carceral sites (n = 3) increased the total number of persons initiating medication for opioid use disorder (MOUD) from April-September 2020, while a third (n = 2) decreased the number of persons initiated. Most CTPs (n = 4) reported a decrease in the number of new admissions from April-September 2020, with two programs stopping or pausing MOUD programs due to COVID-19. All carceral sites with pre-COVID telemedicine use (n = 5) increased or maintained telemedicine use, and all CTPs providing MOUD (n = 6) increased telemedicine use. While expansion of telemedicine services supported MOUD service delivery, the majority of sites experienced challenges providing community support post-release, including referrals to housing, employment, and transportation services. During the COVID-19 pandemic, this small sample of carceral and CTP sites innovated to continue delivery of treatment for OUD. Expansion of telemedicine services was critical to support MOUD service delivery. Despite these innovations, sites experienced challenges providing reintegration supports for persons in the community. Pre-COVID strategies for identifying and engaging individuals while incarcerated may be less effective since the pandemic. In addition to expanding research on the most effective telemedicine practices for carceral settings, research exploring strategies to expand housing and employment support during reintegration are critical.
Collapse
Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, USA.
| | - Milan F Satcher
- Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Ryan D McDonald
- New York University Grossman School of Medicine, New York, NY, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - David Farabee
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Amesika Nyaku
- Division of Infectious Diseases, Rutgers New Jersey Medical School, New Brunswick, NJ, USA
| | - Donald Reeves
- Rutgers University Correctional Health Care, Rutgers-Robert Wood Johnson Medical School, Trenton, NJ, USA
| | - Lynn E Kunkel
- Oregon Health and Science University -Portland State University School of Public Health and Addiction Medicine Section, Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Alysse M Schultheis
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | - Joshua D Lee
- New York University Grossman School of Medicine, New York, NY, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, USA
| | - Elizabeth Needham Waddell
- Oregon Health and Science University -Portland State University School of Public Health and Addiction Medicine Section, Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
15
|
Stafylis C, Vavala G, Wang Q, McLeman B, Lemley SM, Young SD, Xie H, Matthews AG, Oden N, Revoredo L, Shmueli-Blumberg D, Hichborn EG, McKelle E, Moran LM, Jacobs P, Marsch LA, Klausner JD. Relative Effectiveness of Social Media, Dating Apps, and Information Search Sites in Promoting HIV Self-testing: Observational Cohort Study. JMIR Form Res 2022; 6:e35648. [PMID: 36149729 PMCID: PMC9591705 DOI: 10.2196/35648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Social media sites, dating apps, and information search sites have been used to reach individuals at high risk for HIV infection. However, it is not clear which platform is the most efficient in promoting home HIV self-testing, given that the users of various platforms may have different characteristics that impact their readiness for HIV testing. Objective This study aimed to compare the relative effectiveness of social media sites, dating apps, and information search sites in promoting HIV self-testing among minority men who have sex with men (MSM) at an increased risk of HIV infection. Test kit order rates were used as a proxy to evaluate promotion effectiveness. In addition, we assessed differences in characteristics between participants who ordered and did not order an HIV test kit. Methods Culturally appropriate advertisements were placed on popular sites of three different platforms: social media sites (Facebook, Instagram), dating apps (Grindr, Jack’D), and information search sites (Google, Bing). Advertisements targeted young (18-30 years old) and minority (Black or Latinx) MSM at risk of HIV exposure. Recruitment occurred in 2 waves, with each wave running advertisements on 1 platform of each type over the same period. Participants completed a baseline survey assessing sexual or injection use behavior, substance use including alcohol, psychological readiness to test, attitudes toward HIV testing and treatment, and HIV-related stigma. Participants received an electronic code to order a free home-based HIV self-test kit. Follow-up assessments were conducted to assess HIV self-test kit use and uptake of pre-exposure prophylaxis (PrEP) at 14 and 60 days post enrollment. Results In total, 271 participants were enrolled, and 254 were included in the final analysis. Among these 254 participants, 177 (69.7%) ordered a home HIV self-test kit. Most of the self-test kits were ordered by participants enrolled from dating apps. Due to waves with low enrollment, between wave statistical comparisons were not feasible. Within wave comparison revealed that Jack’D showed higher order rates (3.29 kits/day) compared to Instagram (0.34 kits/day) and Bing (0 kits/day). There were no associations among self-test kit ordering and HIV-related stigma, perceptions about HIV testing and treatment, and mistrust of medical organizations. Conclusions Our findings show that using popular dating apps might be an efficient way to promote HIV self-testing. Stigma, perceptions about HIV testing and treatment, or mistrust of medical organizations may not affect order rates of HIV test kits promoted on the internet. Trial Registration ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502 International Registered Report Identifier (IRRID) RR2-10.2196/20417
Collapse
Affiliation(s)
- Chrysovalantis Stafylis
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Gabriella Vavala
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Qiao Wang
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Bethany McLeman
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Shea M Lemley
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Sean D Young
- Department of Emergency Medicine, School of Medicine, University of California, Irvine, Irvine, CA, United States
- Department of Informatics, Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, CA, United States
| | - Haiyi Xie
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Neal Oden
- The Emmes Company LLC, Rockville, MD, United States
| | - Leslie Revoredo
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Emily G Hichborn
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Erin McKelle
- Education, Training and Research Associates, Oakland, CA, United States
| | - Landhing M Moran
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Petra Jacobs
- National Institute on Aging, Bethesda, MD, United States
| | - Lisa A Marsch
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
16
|
Gómez-Restrepo C, Cepeda M, Torrey WC, Suarez-Obando F, Uribe-Restrepo JM, Park S, Acosta MPJ, Camblor PM, Castro SM, Aguilera-Cruz J, González L, Chaparro N, Gómez-Gamez AM, Bell K, Marsch LA. Perceived access to general and mental healthcare in primary care in Colombia during COVID-19: A cross-sectional study. Front Public Health 2022; 10:896318. [PMID: 36159257 PMCID: PMC9490130 DOI: 10.3389/fpubh.2022.896318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/19/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction The COVID-19 pandemic has had an impact both in general and mental healthcare, challenged the health systems worldwide, and affected their capacity to deliver essential health services. We aimed to describe perceived changes in ease of access to general and mental healthcare among patients with a diagnosis of depression and/or unhealthy alcohol use in Colombia. Methods This study is embedded in the DIADA project, a multicenter implementation research study aimed at evaluating the integration of mental healthcare in primary care in Colombia. Between November 2020 and August 2021, we conducted a COVID-19 pandemic impact assessment in a cohort of participants with newly diagnosed depression and/or unhealthy alcohol use part of DIADA project. We assessed the ease of access and factors related to perceived ease of access to general or mental healthcare, during the COVID-19 pandemic. Results 836 participants completed the COVID-19 pandemic impact assessment. About 30% of participants considered their mental health to be worse during the pandemic and 84.3% perceived access to general healthcare to be worse during the pandemic. Most of participants (85.8%) were unable to assess access to mental health services, but a significant proportion considered it to be worse. Experiencing worse ease of access to general healthcare was more frequent among women, patients with diagnosis of depression, and patients with comorbidities. Experiencing worse ease of access to mental healthcare was more frequent among patients aged between 30 and 49.9 years, from socioeconomic status between 4 and 6, affiliated to the contributive social security regime, attending urban study sites, and those who perceived their mental health was worse during the pandemic. Discussion Despite the overall perception of worse mental health during the pandemic, the use of mental healthcare was low compared to general healthcare. Ease of access was perceived to be worse compared to pre-pandemic. Ease of access and access were affected by geographical study site, socioeconomic status, age and gender. Our findings highlight the need for improved communication between patients and institutions, tailored strategies to adapt the healthcare provision to patients' characteristics, and continued efforts to strengthen the role of mental healthcare provision in primary care.
Collapse
Affiliation(s)
- Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Magda Cepeda
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia,*Correspondence: Magda Cepeda
| | - William C. Torrey
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | | | | | - Sena Park
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - María Paula Jassir Acosta
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martínez Camblor
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Sergio M. Castro
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jeny Aguilera-Cruz
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lilian González
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Natalia Chaparro
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana María Gómez-Gamez
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
17
|
Lenert LA, Zhu V, Jennings L, McCauley JL, Obeid JS, Ward R, Hassanpour S, Marsch LA, Hogarth M, Shipman P, Harris DR, Talbert JC. Enhancing research data infrastructure to address the opioid epidemic: the Opioid Overdose Network (O2-Net). JAMIA Open 2022; 5:ooac055. [PMID: 35783072 PMCID: PMC9243402 DOI: 10.1093/jamiaopen/ooac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/11/2022] [Accepted: 06/17/2022] [Indexed: 02/05/2023] Open
Abstract
Opioid Overdose Network is an effort to generalize and adapt an existing research data network, the Accrual to Clinical Trials (ACT) Network, to support design of trials for survivors of opioid overdoses presenting to emergency departments (ED). Four institutions (Medical University of South Carolina [MUSC], Dartmouth Medical School [DMS], University of Kentucky [UK], and University of California San Diego [UCSD]) worked to adapt the ACT network. The approach that was taken to enhance the ACT network focused on 4 activities: cloning and extending the ACT infrastructure, developing an e-phenotype and corresponding registry, developing portable natural language processing tools to enhance data capture, and developing automated documentation templates to enhance extended data capture. Overall, initial results suggest that tailoring of existing multipurpose federated research networks to specific tasks is feasible; however, substantial efforts are required for coordination of the subnetwork and development of new tools for extension of available data. The initial output of the project was a new approach to decision support for the prescription of naloxone for home use in the ED, which is under further study within the network.
Collapse
Affiliation(s)
- Leslie A Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vivienne Zhu
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lindsey Jennings
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jenna L McCauley
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jihad S Obeid
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ralph Ward
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Saeed Hassanpour
- Biomedical Data Science Department, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Michael Hogarth
- Department of Biomedical Informatics, University of California San Diego, San Diego, California, USA
| | - Perry Shipman
- Altman Clinical and Translational Research Institute, University of California San Diego, San Diego, California, USA
| | - Daniel R Harris
- Institute for Biomedical Informatics, University of Kentucky, Lexington, Kentucky, USA
| | - Jeffery C Talbert
- Institute for Biomedical Informatics, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
18
|
Janzow GE, Harding C, Flores M, Borodovsky J, Steinkamp J, Marsch LA, Schuman-Olivier Z. Assessing the feasibility, usability and acceptability of the MySafeRx platform among individuals in outpatient buprenorphine treatment: Lessons learned from a pilot randomized controlled trial. Drug Alcohol Depend Rep 2022; 3:100045. [PMID: 36845988 PMCID: PMC9949338 DOI: 10.1016/j.dadr.2022.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Background Increasing buprenorphine/naloxone (B/N) access for opioid use disorder (OUD) is essential yet ensuring adherence and preventing diversion remains challenging. This study examines the feasibility, usability, and acceptability of MySafeRx, a mobile platform integrating motivational coaching, adherence monitoring, and electronic dispensing during office-based B/N treatment. Methods In this multi-site randomized controlled trial, MySafeRx provided coaching and supervised self-administration of B/N by mobile recovery coaches (MRCs) via videoconference. Referred adults (ages 18-65) with OUD were randomized to 1) 42-days of adjunctive MySafeRx treatment (n = 13) or 2) a standard care control group (n = 14). Results The randomized sample was 63% female and 100% White. Twelve of 13 MySafeRx participants completed at least one MRC session. The mean system usability score reported by MySafeRx participants was 78.4 (n = 12). Participants indicated they would recommend MySafeRx to a friend (mean= 4.1 of 5), and that the dispenser (4.1 of 5) and videoconferencing (4.2 of 5) were easy to use. The MRC component had the highest acceptability (4.4 of 5). MRCs observed B/N self-administration for an average of 64.3% of the required study days (men: 68.9%; women: 57.9%). On average, men (n = 4) met with MRCs on 32±14 days versus 47±6 days for women (n = 8). Exploratory analyses did not show significant differences between intervention and control groups. Conclusions Despite the small sample, this study supports usability and acceptability of MySafeRx. Increased adherence monitoring, even with remote coaching had limited appeal, which impacted feasibility due to slow recruitment, especially as community prescribing with relaxed monitoring requirements became more widespread.
Collapse
Affiliation(s)
- Grace E. Janzow
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Cassandra Harding
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Michael Flores
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
| | - Jackson Steinkamp
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
| |
Collapse
|
19
|
Aldridge LR, Kemp CG, Bass JK, Danforth K, Kane JC, Hamdani SU, Marsch LA, Uribe-Restrepo JM, Nguyen AJ, Bolton PA, Murray LK, Haroz EE. Psychometric performance of the Mental Health Implementation Science Tools (mhIST) across six low- and middle-income countries. Implement Sci Commun 2022; 3:54. [PMID: 35590428 PMCID: PMC9118868 DOI: 10.1186/s43058-022-00301-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/26/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Existing implementation measures developed in high-income countries may have limited appropriateness for use within low- and middle-income countries (LMIC). In response, researchers at Johns Hopkins University began developing the Mental Health Implementation Science Tools (mhIST) in 2013 to assess priority implementation determinants and outcomes across four key stakeholder groups-consumers, providers, organization leaders, and policy makers-with dedicated versions of scales for each group. These were field tested and refined in several contexts, and criterion validity was established in Ukraine. The Consumer and Provider mhIST have since grown in popularity in mental health research, outpacing psychometric evaluation. Our objective was to establish the cross-context psychometric properties of these versions and inform future revisions. METHODS We compiled secondary data from seven studies across six LMIC-Colombia, Myanmar, Pakistan, Thailand, Ukraine, and Zambia-to evaluate the psychometric performance of the Consumer and Provider mhIST. We used exploratory factor analysis to identify dimensionality, factor structure, and item loadings for each scale within each stakeholder version. We also used alignment analysis (i.e., multi-group confirmatory factor analysis) to estimate measurement invariance and differential item functioning of the Consumer scales across the six countries. RESULTS All but one scale within the Provider and Consumer versions had Cronbach's alpha greater than 0.8. Exploratory factor analysis indicated most scales were multidimensional, with factors generally aligning with a priori subscales for the Provider version; the Consumer version has no predefined subscales. Alignment analysis of the Consumer mhIST indicated a range of measurement invariance for scales across settings (R2 0.46 to 0.77). Several items were identified for potential revision due to participant nonresponse or low or cross- factor loadings. We found only one item, which asked consumers whether their intervention provider was available when needed, to have differential item functioning in both intercept and loading. CONCLUSION We provide evidence that the Consumer and Provider versions of the mhIST are internally valid and reliable across diverse contexts and stakeholder groups for mental health research in LMIC. We recommend the instrument be revised based on these analyses and future research examine instrument utility by linking measurement to other outcomes of interest.
Collapse
Affiliation(s)
- Luke R Aldridge
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.
| | - Christopher G Kemp
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Judith K Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Kristen Danforth
- University of Washington Department of Global Health, Seattle, USA
| | - Jeremy C Kane
- Columbia University Mailman School of Public Health, New York, USA
| | - Syed U Hamdani
- University of Liverpool Institute of Population Health, Liverpool, UK
| | - Lisa A Marsch
- Dartmouth Center for Technology & Behavioral Health, Lebanon, USA
| | - José M Uribe-Restrepo
- Pontificia Universidad Javeriana Department of Psychiatry and Mental Health, Bogota, Colombia
| | - Amanda J Nguyen
- University of Virginia School of Education and Human Development, Charlottesville, USA
| | - Paul A Bolton
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Laura K Murray
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Emily E Haroz
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| |
Collapse
|
20
|
Hichborn EG, Moore SK, Gauthier PR, Agosti NO, Bell KD, Boggis JS, Lambert-Harris CA, Saunders EC, Turner AM, McLeman BM, Marsch LA. Technology-Based Interventions in Substance Use Treatment to Promote Health Equity Among People Who Identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e34508. [PMID: 35579930 PMCID: PMC9157317 DOI: 10.2196/34508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/05/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Technology-based interventions (TBIs; ie, web-based and mobile interventions) have the potential to promote health equity in substance use treatment (SUTx) for underrepresented groups (people who identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native) by removing barriers and increasing access to culturally relevant effective treatments. However, technologies (emergent and more long-standing) may have unintended consequences that could perpetuate health care disparities among people who identify as a member of one of the underrepresented groups. Health care research, and SUTx research specifically, is infrequently conducted with people who identify with these groups as the main focus. Therefore, an improved understanding of the literature at the intersection of SUTx, TBIs, and underrepresented groups is warranted to avoid exacerbating inequities and to promote health equity. OBJECTIVE This study aims to explore peer-reviewed literature (January 2000-March 2021) that includes people who identify as a member of one of the underrepresented groups in SUTx research using TBIs. We further seek to explore whether this subset of research is race/ethnicity conscious (does the research consider members of underrepresented groups beyond their inclusion as study participants in the introduction, methods, results, or discussion). METHODS Five electronic databases (MEDLINE, Scopus, Cochrane Library, CINAHL, and PsycInfo) were searched to identify SUTx research using TBIs, and studies were screened for eligibility at the title/abstract and full-text levels. Studies were included if their sample comprised of people who identify as a member of one of the underrepresented groups at 50% or more when combined. RESULTS Title/abstract and full-text reviews were completed in 2021. These efforts netted a sample of 185 studies that appear to meet inclusionary criteria. Due to the uniqueness of tobacco relative to other substances in the SUTx space, as well as the large number of studies netted, we plan to separately publish a scoping review on tobacco-focused studies that meet all other criteria. Filtering for tobacco-focused studies (n=31) netted a final full-text sample for a main scoping review of 154 studies. The tobacco-focused scoping review manuscript is expected to be submitted for peer review in Spring 2022. The main scoping review data extraction and data validation to confirm the accuracy and consistency of data extraction across records was completed in March 2022. We expect to publish the main scoping review findings by the end of 2022. CONCLUSIONS Research is needed to increase our understanding of the range and nature of TBIs being used in SUTx research studies with members of underrepresented groups. The planned scoping review will highlight research at this intersection to promote health equity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34508.
Collapse
Affiliation(s)
- Emily G Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Phoebe R Gauthier
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Nico O Agosti
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Kathleen D Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Jesse S Boggis
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Chantal A Lambert-Harris
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Avery M Turner
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Bethany M McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
21
|
Scherer EA, Kim SJ, Metcalf SA, Sweeney MA, Wu J, Xie H, Mazza GL, Valente MJ, MacKinnon DP, Marsch LA. Momentary Self-regulation: Scale Development and Preliminary Validation. JMIR Ment Health 2022; 9:e35273. [PMID: 35536605 PMCID: PMC9131140 DOI: 10.2196/35273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Self-regulation refers to a person's ability to manage their cognitive, emotional, and behavioral processes to achieve long-term goals. Most prior research has examined self-regulation at the individual level; however, individual-level assessments do not allow the examination of dynamic patterns of intraindividual variability in self-regulation and thus cannot aid in understanding potential malleable processes of self-regulation that may occur in response to the daily environment. OBJECTIVE This study aims to develop a brief, psychometrically sound momentary self-regulation scale that can be practically administered through participants' mobile devices at a momentary level. METHODS This study was conducted in 2 phases. In the first phase, in a sample of 522 adults collected as part of a larger self-regulation project, we examined 23 previously validated assessments of self-regulation containing 594 items in total to evaluate the underlying structure of self-regulation via exploratory and confirmatory factor analyses. We then selected 20 trait-level items to be carried forward to the second phase. In the second phase, we converted each item into a momentary question and piloted the momentary items in a sample of 53 adults over 14 days. Using the results from the momentary pilot study, we explored the psychometric properties of the items and assessed their underlying structure. We then proposed a set of subscale and total score calculations. RESULTS In the first phase, the selected individual-level items appeared to measure 4 factors of self-regulation. The factors identified were perseverance, sensation seeking, emotion regulation, and mindfulness. In the second phase of the ecological momentary assessment pilot, the selected items demonstrated strong construct validity as well as predictive validity for health risk behaviors. CONCLUSIONS Our findings provide preliminary evidence for a 12-item momentary self-regulation scale comprising 4 subscales designed to capture self-regulatory dynamics at the momentary level.
Collapse
Affiliation(s)
- Emily A Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Health Communication and Digital Innovation, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Stephen A Metcalf
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Mary Ann Sweeney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Jialing Wu
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- School of Media and Design, Shanghai JiaoTong University, Shanghai, China
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Haiyi Xie
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Gina L Mazza
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, United States
| | - Matthew J Valente
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, United States
| | - David P MacKinnon
- Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| |
Collapse
|
22
|
Aronson ID, Zhang J, Rajan S, Marsch LA, Bugaighis M, Ibitoye MO, Chernick LS, Des Jarlais DC. Automated Substance Use/Sexual Risk Reporting and HIV Test Acceptance Among Emergency Department Patients Aged 13-24 Years. AIDS Behav 2022; 26:1544-1551. [PMID: 34705152 PMCID: PMC9007819 DOI: 10.1007/s10461-021-03507-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/28/2022]
Abstract
Despite federal guidelines, many adolescents and emerging adults are not offered HIV testing by their healthcare providers. As such, many-including those who may be at high-risk for contracting HIV given their sexual and/or substance use risk-are not routinely tested. The current study examines sexual risk and substance use among emergency department patients aged 13-24 years (n = 147), who completed an automated screening as part of a tablet-based intervention designed to increase HIV testing. Twenty seven percent (n = 39) of participants chose to test for HIV after completing the tablet-based intervention. Among this sample, sexual risk was a significant independent predictor of HIV testing (χ2 = 16.50, p < 0.001). Problem substance use (e.g. trying but failing to quit) also predicted testing (χ2 = 7.43, p < 0.01). When considering these behaviors together, analyses indicated that the effect of problem substance use (ß = 0.648, p = 0.154) on testing is explained by sexual risk behavior (ß = 1.425, p < 0.01). The study's findings underscore the value of using routine automated risk screenings to collect sensitive data from emergency department patients, followed by computer-based HIV test offers for adolescent youth. Our research indicates tablet-based interventions can facilitate more accurate reporting of sexual behavior and substance use, and can also potentially increase HIV test uptake among those at risk.
Collapse
Affiliation(s)
- Ian David Aronson
- Digital Health Empowerment, Brooklyn, NY, USA.
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
| | - Jingru Zhang
- Teachers College, Columbia University, New York, NY, USA
| | - Sonali Rajan
- Teachers College, Columbia University, New York, NY, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, USA
| | - Mona Bugaighis
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Lauren S Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| |
Collapse
|
23
|
Marsch LA, Chen CH, Adams SR, Asyyed A, Does MB, Hassanpour S, Hichborn E, Jackson-Morris M, Jacobson NC, Jones HK, Kotz D, Lambert-Harris CA, Li Z, McLeman B, Mishra V, Stanger C, Subramaniam G, Wu W, Campbell CI. The Feasibility and Utility of Harnessing Digital Health to Understand Clinical Trajectories in Medication Treatment for Opioid Use Disorder: D-TECT Study Design and Methodological Considerations. Front Psychiatry 2022; 13:871916. [PMID: 35573377 PMCID: PMC9098973 DOI: 10.3389/fpsyt.2022.871916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Across the U.S., the prevalence of opioid use disorder (OUD) and the rates of opioid overdoses have risen precipitously in recent years. Several effective medications for OUD (MOUD) exist and have been shown to be life-saving. A large volume of research has identified a confluence of factors that predict attrition and continued substance use during substance use disorder treatment. However, much of this literature has examined a small set of potential moderators or mediators of outcomes in MOUD treatment and may lead to over-simplified accounts of treatment non-adherence. Digital health methodologies offer great promise for capturing intensive, longitudinal ecologically-valid data from individuals in MOUD treatment to extend our understanding of factors that impact treatment engagement and outcomes. Methods This paper describes the protocol (including the study design and methodological considerations) from a novel study supported by the National Drug Abuse Treatment Clinical Trials Network at the National Institute on Drug Abuse (NIDA). This study (D-TECT) primarily seeks to evaluate the feasibility of collecting ecological momentary assessment (EMA), smartphone and smartwatch sensor data, and social media data among patients in outpatient MOUD treatment. It secondarily seeks to examine the utility of EMA, digital sensing, and social media data (separately and compared to one another) in predicting MOUD treatment retention, opioid use events, and medication adherence [as captured in electronic health records (EHR) and EMA data]. To our knowledge, this is the first project to include all three sources of digitally derived data (EMA, digital sensing, and social media) in understanding the clinical trajectories of patients in MOUD treatment. These multiple data streams will allow us to understand the relative and combined utility of collecting digital data from these diverse data sources. The inclusion of EHR data allows us to focus on the utility of digital health data in predicting objectively measured clinical outcomes. Discussion Results may be useful in elucidating novel relations between digital data sources and OUD treatment outcomes. It may also inform approaches to enhancing outcomes measurement in clinical trials by allowing for the assessment of dynamic interactions between individuals' daily lives and their MOUD treatment response. Clinical Trial Registration Identifier: NCT04535583.
Collapse
Affiliation(s)
- Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Ching-Hua Chen
- Center for Computational Health, International Business Machines (IBM) Research, Yorktown Heights, NY, United States
| | - Sara R. Adams
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States
| | - Asma Asyyed
- The Permanente Medical Group, Northern California, Addiction Medicine and Recovery Services, Oakland, CA, United States
| | - Monique B. Does
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States
| | - Saeed Hassanpour
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Emily Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Nicholas C. Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Heather K. Jones
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States
| | - David Kotz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Chantal A. Lambert-Harris
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Zhiguo Li
- Center for Computational Health, International Business Machines (IBM) Research, Yorktown Heights, NY, United States
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Varun Mishra
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Geetha Subramaniam
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Weiyi Wu
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Cynthia I. Campbell
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
24
|
Scherer EA, Metcalf SA, Whicker CL, Bartels SM, Grabinski M, Kim SJ, Sweeney MA, Lemley SM, Lavoie H, Xie H, Bissett PG, Dallery J, Kiernan M, Lowe MR, Onken L, Prochaska JJ, Stoeckel LE, Poldrack RA, MacKinnon DP, Marsch LA. Momentary Influences on Self-Regulation in Two Populations With Health Risk Behaviors: Adults Who Smoke and Adults Who Are Overweight and Have Binge-Eating Disorder. Front Digit Health 2022; 4:798895. [PMID: 35373179 PMCID: PMC8971561 DOI: 10.3389/fdgth.2022.798895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Self-regulation has been implicated in health risk behaviors and is a target of many health behavior interventions. Despite most prior research focusing on self-regulation as an individual-level trait, we hypothesize that self-regulation is a time-varying mechanism of health and risk behavior that may be influenced by momentary contexts to a substantial degree. Because most health behaviors (e.g., eating, drinking, smoking) occur in the context of everyday activities, digital technologies may help us better understand and influence these behaviors in real time. Using a momentary self-regulation measure, the current study (which was part of a larger multi-year research project on the science of behavior change) used ecological momentary assessment (EMA) to assess if self-regulation can be engaged and manipulated on a momentary basis in naturalistic, non-laboratory settings. Methods This one-arm, open-label exploratory study prospectively collected momentary data for 14 days from 104 participants who smoked regularly and 81 participants who were overweight and had binge-eating disorder. Four times per day, participants were queried about momentary self-regulation, emotional state, and social and environmental context; recent smoking and exposure to smoking cues (smoking sample only); and recent eating, binge eating, and exposure to binge-eating cues (binge-eating sample only). This study used a novel, momentary self-regulation measure comprised of four subscales: momentary perseverance, momentary sensation seeking, momentary self-judgment, and momentary mindfulness. Participants were also instructed to engage with Laddr, a mobile application that provides evidence-based health behavior change tools via an integrated platform. The association between momentary context and momentary self-regulation was explored via mixed-effects models. Exploratory assessments of whether recent Laddr use (defined as use within 12 h of momentary responses) modified the association between momentary context and momentary self-regulation were performed via mixed-effects models. Results Participants (mean age 35.2; 78% female) in the smoking and binge-eating samples contributed a total of 3,233 and 3,481 momentary questionnaires, respectively. Momentary self-regulation subscales were associated with several momentary contexts, in the combined as well as smoking and binge-eating samples. For example, in the combined sample momentary perseverance was associated with location, positively associated with positive affect, and negatively associated with negative affect, stress, and tiredness. In the smoking sample, momentary perseverance was positively associated with momentary difficulty in accessing cigarettes, caffeine intake, and momentary restraint in smoking, and negatively associated with temptation and urge to smoke. In the binge-eating sample, momentary perseverance was positively associated with difficulty in accessing food and restraint in eating, and negatively associated with urge to binge eat. While recent Laddr use was not associated directly with momentary self-regulation subscales, it did modify several of the contextual associations, including challenging contexts. Conclusions Overall, this study provides preliminary evidence that momentary self-regulation may vary in response to differing momentary contexts in samples from two exemplar populations with risk behaviors. In addition, the Laddr application may modify some of these relationships. These findings demonstrate the possibility of measuring momentary self-regulation in a trans-diagnostic way and assessing the effects of momentary, mobile interventions in context. Health behavior change interventions may consider measuring and targeting momentary self-regulation in addition to trait-level self-regulation to better understand and improve health risk behaviors. This work will be used to inform a later stage of research focused on assessing the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and health outcomes. Clinical Trial Registration ClinicalTrials.gov, Identifier: NCT03352713.
Collapse
Affiliation(s)
- Emily A Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Stephen A Metcalf
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Cady L Whicker
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Sophia M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Michael Grabinski
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.,Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Mary Ann Sweeney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Shea M Lemley
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Hannah Lavoie
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States
| | - Haiyi Xie
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Patrick G Bissett
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - Michaela Kiernan
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Michael R Lowe
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Lisa Onken
- National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Luke E Stoeckel
- National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
| | - Russell A Poldrack
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - David P MacKinnon
- Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
25
|
Schlieter H, Marsch LA, Whitehouse D, Otto L, Londral AR, Teepe GW, Benedict M, Ollier J, Ulmer T, Gasser N, Ultsch S, Wollschlaeger B, Kowatsch T. Scale-up of Digital Innovations in Health Care: Expert Commentary on Enablers and Barriers. J Med Internet Res 2022; 24:e24582. [PMID: 35275065 PMCID: PMC8956989 DOI: 10.2196/24582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/17/2021] [Accepted: 12/28/2021] [Indexed: 12/13/2022] Open
Abstract
Health care delivery is undergoing a rapid change from traditional processes toward the use of digital health interventions and personalized medicine. This movement has been accelerated by the COVID-19 crisis as a response to the need to guarantee access to health care services while reducing the risk of contagion. Digital health scale-up is now also vital to achieve population-wide impact: it will only accomplish sustainable effects if and when deployed into regular health care delivery services. The question of how sustainable digital health scale-up can be successfully achieved has, however, not yet been sufficiently resolved. This paper identifies and discusses enablers and barriers for scaling up digital health innovations. The results discussed in this paper were gathered by scientists and representatives of public bodies as well as patient organizations at an international workshop on scaling up digital health innovations. Results are explored in the context of prior research and implications for future work in achieving large-scale implementations that will benefit the population as a whole.
Collapse
Affiliation(s)
- Hannes Schlieter
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Lena Otto
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany
| | - Ana Rita Londral
- Value for Health CoLAB, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Gisbert Wilhelm Teepe
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Martin Benedict
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany
| | - Joseph Ollier
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Tom Ulmer
- Institute of Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | | | - Sabine Ultsch
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Bastian Wollschlaeger
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
26
|
Metcalf SA, Saunders EC, Moore SK, Walsh O, Meier A, Auty S, Bessen SY, Marsch LA. Compassion, stigma, and professionalism among emergency personnel responding to the opioid crisis: An exploratory study in New Hampshire, USA. J Am Coll Emerg Physicians Open 2022; 3:e12641. [PMID: 35059691 PMCID: PMC8758975 DOI: 10.1002/emp2.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Drug overdoses are the leading cause of death in the United States for those under 50 years of age, and New Hampshire has been disproportionately affected, resulting in increased encounters with the emergency response system. The ensuing impact on emergency personnel has received little attention. The present study aimed to explore the experiences and perspectives of emergency personnel responding to the opioid crisis in NH, with a focus on their views toward people who use opioids. METHODS Thirty-six emergency personnel (emergency department clinicians, n = 18; emergency medical service providers, n = 6; firefighters, n = 6; and police officers, n = 6) in 6 New Hampshire counties were interviewed about their experiences responding to overdoses and their perspectives on individuals who use opioids. Directed content analysis was used to identify themes in the transcribed, semistructured interviews. The results were reviewed for consensus. RESULTS Several categories of themes were identified among emergency personnel's accounts of their overdose response experiences and perspectives, including varied degrees of compassion and stigma toward people who use opioids; associations between compassion or stigma and policy- and practice-related themes, such as prehospital emergency care and the role of emergency departments (EDs); and primarily among personnel expressing compassion, a sense of professional responsibility that outweighed personal biases. CONCLUSIONS Despite the magnitude of the ongoing opioid crisis, some emergency personnel in New Hampshire have sustained or increased their compassion for people who use opioids. Others' perspectives remain or have become increasingly stigmatizing. The associations of compassion and stigma with various policy- and practice-related themes warrant further investigation.
Collapse
Affiliation(s)
- Stephen A. Metcalf
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Elizabeth C. Saunders
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| | - Sarah K. Moore
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| | - Olivia Walsh
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
- Mandel School of Applied Social SciencesCase Western Reserve UniversityClevelandOhioUSA
| | - Andrea Meier
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| | - Samantha Auty
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Sarah Y. Bessen
- Geisel School of Medicine at Dartmouth CollegeHanoverNew HampshireUSA
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Lisa A. Marsch
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| |
Collapse
|
27
|
Marsch LA, Gómez-Restrepo C, Bartels SM, Bell K, Camblor PM, Castro S, Cárdenas Charry MP, Cepeda M, Cubillos L, John D, Jassir MP, Lemley SM, Suárez-Obando F, Torrey WC, Uribe JM, Williams MJ. Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project. Psychiatr Serv 2022; 73:196-205. [PMID: 34347504 PMCID: PMC8810677 DOI: 10.1176/appi.ps.202000041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mental disorders are a major cause of the global burden of disease and significantly contribute to disability and death. This challenge is particularly evident in low- and middle-income countries (LMICs), where >85% of the world's population live. Latin America is one region comprising LMICs where the burden of mental disorders is high and the availability of mental health services is low. This is particularly evident in Colombia, a country with a long-standing history of violence and associated mental health problems. METHODS This article describes the design of a multisite implementation science project, "Scaling Up Science-Based Mental Health Interventions in Latin America" (also known as the DIADA project), that is being conducted in six primary care systems in Colombia. This project, funded via a cooperative agreement from the National Institute of Mental Health, seeks to implement and assess the impact of a new model for promoting widespread access to mental health care for depression and unhealthy alcohol use within primary care settings and building an infrastructure to support research capacity and sustainability of the new service delivery model in Colombia. This care model centrally harnesses mobile health technology to increase the reach of science-based mental health care for depression and unhealthy alcohol use. RESULTS This initiative offers great promise to increase capacity for providing and sustaining evidence-based treatment for depression and unhealthy alcohol use in Colombia. NEXT STEPS This project may inform models of care that can extend to other regions of Latin America or other LMICs.
Collapse
Affiliation(s)
- Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Carlos Gómez-Restrepo
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Sophie M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Pablo Martinez Camblor
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Sergio Castro
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Maria Paula Cárdenas Charry
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Magda Cepeda
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Deepak John
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Maria Paula Jassir
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Shea M Lemley
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Fernando Suárez-Obando
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - William C Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - José Miguel Uribe
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Makeda J Williams
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| |
Collapse
|
28
|
Saunders EC, Budney AJ, Cavazos-Rehg P, Scherer E, Marsch LA. Comparing the feasibility of four web-based recruitment strategies to evaluate the treatment preferences of rural and urban adults who misuse non-prescribed opioids. Prev Med 2021; 152:106783. [PMID: 34499972 PMCID: PMC8545866 DOI: 10.1016/j.ypmed.2021.106783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 02/07/2023]
Abstract
This cross-sectional study examined the feasibility of using four different web-based strategies to recruit rural and urban adults who use opioids non-medically for a survey on opioid use disorder (OUD) treatment preferences, and compared the treatment preferences of rural versus urban participants. Preferences for medication for opioid use disorder (MOUD) formulation and OUD treatment models were assessed through an online survey. Recruitment advertisements were shown on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (MTurk). Participants were categorized by zip code into urban versus rural residence using the Centers for Medicaid and Medicaid Health Resources and Services Administration definitions. OUD treatment preferences were compared using chi-square and t-tests. Among the 851 participants recruited, 815 provided zip codes and were classified as residing in rural (n = 200, 24.5%) or urban (n = 615, 75.4%) regions. A crowdsourcing service (MTurk) recruited the most rural participants, while posts on a social news website (Reddit) recruited the most urban participants (χ23 = 17.0, p < 0.01). While preferred MOUD formulation and OUD treatment model did not differ by rurality, rural participants were more likely to report a willingness to receive OUD treatment integrated with general medical care (χ21 = 18.9, p < 0.0001). This study demonstrated that web-based strategies are feasible for recruiting rural adults who misuse opioids. Results suggest OUD treatment preferences largely did not differ by rural residence, and highlight the importance of enhancing the availability and increasing education about MOUD formulations in rural regions.
Collapse
Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| |
Collapse
|
29
|
Moore SK, Saunders EC, McLeman B, Metcalf SA, Walsh O, Bell K, Meier A, Marsch LA. Implementation of a New Hampshire community-initiated response to the opioid crisis: A mixed-methods process evaluation of Safe Station. Int J Drug Policy 2021; 95:103259. [PMID: 33933923 PMCID: PMC8530836 DOI: 10.1016/j.drugpo.2021.103259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND New Hampshire (NH) ranked first for fentanyl- and all opioid-related overdose deaths per capita from 2014 to 2016 and third in 2017 with no rate reduction from the previous year relative to all other states in the US. In response to the opioid crisis in NH, Manchester Fire Department (MFD), the state's largest city fire department, launched the Safe Station program in 2016 in partnership with other community organizations. This community-based response to the crisis-described as a connection to recovery-focuses on reducing barriers to accessing resources for people with substance use and related problems. The study aim is to characterize the multi-organizational partnerships and workflow of the Safe Station model and identify key components that are engaging, effective, replicable, and sustainable. METHODS A mixed-methods design included: semi-structured qualitative interviews conducted with 110 stakeholders from six groups of community partners (Safe Station clients, MFD staff and leadership, and local emergency department, ambulance, and treatment partner staff); implementation and sustainability surveys (completed by MFD stakeholders); and ethnographic observations conducted at MFD. Qualitative data were content analyzed and coded using the Consolidated Framework for Implementation Research. Survey subscales were scored and evaluated to corroborate the qualitative findings. RESULTS Community partners identified key program characteristics including firefighter compassion, low-threshold access, and immediacy of service linkage. Implementation and sustainability survey data corroborate the qualitative interview and observation data in these areas. All participants agreed that community partnerships are key to the program's success. There were mixed evaluations of the quality of communication among the organizations. CONCLUSION Safe Station is a novel response to the opioid crisis in New Hampshire that offers immediate, non-judgmental access to services for persons with opioid use disorders requiring community-wide engagement and communication. Data convergence provides guidance to the sustainability and replicability of the program.
Collapse
Affiliation(s)
- Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA.
| | - Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA
| | - Stephen A Metcalf
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA
| | - Olivia Walsh
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA
| | - Andrea Meier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA
| |
Collapse
|
30
|
Waddell EN, Springer SA, Marsch LA, Farabee D, Schwartz RP, Nyaku A, Reeves R, Goldfeld K, McDonald RD, Malone M, Cheng A, Saunders EC, Monico L, Gryczynski J, Bell K, Harding K, Violette S, Groblewski T, Martin W, Talon K, Beckwith N, Suchocki A, Torralva R, Wisdom JP, Lee JD. Long-acting buprenorphine vs. naltrexone opioid treatments in CJS-involved adults (EXIT-CJS). J Subst Abuse Treat 2021; 128:108389. [PMID: 33865691 PMCID: PMC8384640 DOI: 10.1016/j.jsat.2021.108389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
The EXIT-CJS (N = 1005) multisite open-label randomized controlled trial will compare retention and effectiveness of extended-release buprenorphine (XR-B) vs. extended-release naltrexone (XR-NTX) to treat opioid use disorder (OUD) among criminal justice system (CJS)-involved adults in six U.S. locales (New Jersey, New York City, Delaware, Oregon, Connecticut, and New Hampshire). With a pragmatic, noninferiority design, this study hypothesizes that XR-B (n = 335) will be noninferior to XR-NTX (n = 335) in retention-in-study-medication treatment (the primary outcome), self-reported opioid use, opioid-positive urine samples, opioid overdose events, and CJS recidivism. In addition, persons with OUD not eligible or interested in the RCT will be recruited into an enhanced treatment as usual arm (n = 335) to examine usual care outcomes in a quasi-experimental observational cohort.
Collapse
Affiliation(s)
- Elizabeth Needham Waddell
- School of Public Health and OHSU School of Medicine, Oregon Health & Science University, United States of America
| | | | | | | | | | - Amesika Nyaku
- The State University of New Jersey, New Jersey Medical School, United States of America
| | - Rusty Reeves
- Rutgers, University Correctional Health Care, Rutgers - Robert Wood Johnson Medical School, United States of America
| | | | | | - Mia Malone
- Friends Research Institute, United States of America
| | - Anna Cheng
- Friends Research Institute, United States of America
| | | | - Laura Monico
- Friends Research Institute, United States of America
| | | | | | - Kasey Harding
- Community Health Center, Inc, United States of America
| | | | | | | | - Kasey Talon
- ROAD to a Better Life, United States of America
| | | | | | | | | | | |
Collapse
|
31
|
Buckheit KA, Nolan J, Possemato K, Maisto S, Rosenblum A, Acosta M, Marsch LA. Insomnia predicts treatment engagement and symptom change: a secondary analysis of a web-based CBT intervention for veterans with PTSD symptoms and hazardous alcohol use. Transl Behav Med 2021; 12:6360365. [PMID: 34463344 DOI: 10.1093/tbm/ibab118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Posttraumatic Stress Disorder (PTSD) and hazardous drinking are highly comorbid, and often more severe than PTSD or hazardous drinking alone. Integrated, web-based interventions for PTSD/hazardous drinking may increase access to care, but have demonstrated equivocal results in reducing PTSD and hazardous drinking. One factor that may explain treatment engagement and symptom change is the presence of insomnia symptoms. The current study conducted secondary data analysis of a randomized controlled trial of an integrated web-based intervention for PTSD symptoms and hazardous drinking to examine insomnia symptoms as predictors of PTSD symptoms, alcohol use, and treatment engagement. In the parent study, 162 veterans in primary care reporting PTSD symptoms and hazardous drinking were randomized to receive either the intervention or treatment as usual. The current study examined insomnia among veterans who received the intervention (n = 81). Regression models tested baseline insomnia symptoms as predictors of treatment engagement, follow-up PTSD symptoms, and alcohol use. Hierarchical regression models tested change in insomnia during treatment as a predictor of follow-up PTSD symptoms and alcohol use. Results showed baseline insomnia predicted treatment engagement and follow-up drinking days, but not PTSD symptoms or heavy drinking days. Although overall change in insomnia was small, it predicted follow-up PTSD and heavy drinking days, but not drinking days. Results are consistent with previous research highlighting the importance of identifying and treating insomnia in the course of integrated treatment for PTSD/hazardous drinking. Future research should investigate how to best integrate insomnia, PTSD, and/or hazardous drinking interventions to maximize treatment engagement.
Collapse
Affiliation(s)
- Katherine A Buckheit
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13204, USA
| | - Jon Nolan
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13204, USA
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13204, USA
| | - Stephen Maisto
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13204, USA.,Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | | | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH 03766, USA
| |
Collapse
|
32
|
Abstract
Since the beginning of the HIV epidemic, there have been more than 75 million cases. Currently, there about 1.2 million living with HIV in the USA. Despite current testing recommendations, test rates continue to be suboptimal. Investigators have studied the use of digital technology to promote HIV testing, especially among high-risk populations. PURPOSE OF REVIEW: This non-systematic review provides an overview of the scientific research between 2015 and 2020 focused on the use of digital technology to bolster HIV testing and suggests novel technologies for exploration. RECENT FINDINGS: A total of 40 studies were included in the review that span a wide range of available technology. Studies effectively increased HIV testing among study participants. Generally, participants in the intervention/exposure groups had significantly higher rates of HIV test uptake compared to participants in the comparison groups at study follow-up. For a variety of reasons (e.g., differences in ways the technologies were used and study design), no digital tool clearly performed better than others, but each have the capacity to increase outreach and self-testing. An exploration of the potential use of nascent technologies is also discussed, as well as the authors' experiences using a number of these technologies in our research.
Collapse
Affiliation(s)
- Romina A Romero
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA
| | - Jeffrey D Klausner
- Division of Disease Prevention, Policy and Global Health, Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Lisa A Marsch
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Sean D Young
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA.
- Department of Informatics, University of California, Irvine, 6091 Bren Hall, Irvine, CA, 92617, USA.
| |
Collapse
|
33
|
Bartels SM, Cardenas P, Uribe-Restrepo JM, Cubillos L, Torrey WC, Castro SM, Williams MJ, Oviedo-Manrique DG, Gómez-Restrepo C, Marsch LA. Barriers and facilitators to the diagnosis and treatment of depression in primary care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives. Rev Colomb Psiquiatr (Engl Ed) 2021; 50 Suppl 1:64-72. [PMID: 34281805 DOI: 10.1016/j.rcpeng.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system. METHODS The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data. RESULTS Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines. DISCUSSION This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
Collapse
Affiliation(s)
- Sophia M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
| | - Paula Cardenas
- Departamento de Epidemiología y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José M Uribe-Restrepo
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA; Departamento de Psiquiatría, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - William C Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA; Departamento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Sergio M Castro
- Departamento de Epidemiología y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Makeda J Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Diana Goretty Oviedo-Manrique
- Departamento de Epidemiología y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Departamento de Epidemiología y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| |
Collapse
|
34
|
Suárez-Obando F, Gómez-Restrepo C, Castro-Diaz S, Paez-Rojas P, Uribe-Restrepo JM, Naslund JA, Torrey WC, Cubillos L, Bartels SM, Williams MJ, Marsch LA. Patterns of digital information and communication technology use among patients at primary health care centres in Colombia: Phase I of the DIADA project. Rev Colomb Psiquiatr (Engl Ed) 2021; 50 Suppl 1:116-132. [PMID: 34257055 DOI: 10.1016/j.rcpeng.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Assess the prevalence and types of digital technology use, as well as the extent to which patients use the internet and mobile devises. Evaluate the socioeconomic characteristics of patients and the possible relation to patterns of technology use in Colombia. Understand the nature of patient technology use in primary care for finding medical information. METHODS A survey was applied to adult patients who attended primary health care centers systems in 6 Colombian cities. The survey inquired about demographic characteristics, insurance, access to services, cell phone use, internet access, and the use of such technology to access health-related services and information. Data was collected and managed using REDCap. Summary statistics on each survey item were calculated and the differences between discrete variables were analyzed using chi-square. Multivariate analyses were performed using logistic regression analysis for binary dependent variables. RESULTS A total of 1580 patients were surveyed across the six study sites. 93% of the patients reported they have a cell phone. Patients from urban healthcare centers showed a higher use of the Internet on their phone than less urban settings. Around half of the surveyed patients reported Internet use (49.7%). Among Internet users, 65% of participants use the Internet looking for health care information. Around one-third of patients use cellphones to arrange clinic visits. Around 24% of participants answered positively for both Whooley's questions. Of those who screened positive on the Whooley questions, 43% reported being moderately anxious, 47% reported being very anxious. 51% reported having moderate pain; 52% reported having severe pain. CONCLUSIONS The patterns of technology use identified in this study are essential for developing future health interventions based on ICT. The design of ICT clinical interventions must take into account the cellphone payment plans, availability of internet connection, advantages, and disadvantages of messenger services, including SMS as a possible alternative to people who do not have smartphones.
Collapse
Affiliation(s)
- Fernando Suárez-Obando
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Colombia.
| | - Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Colombia
| | - Sergio Castro-Diaz
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Colombia
| | | | - José M Uribe-Restrepo
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA
| | - John A Naslund
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA
| | - William C Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA
| | - Sophia M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA
| | - Makeda J Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA
| |
Collapse
|
35
|
Gómez-Restrepo C, Marsch LA. Scaling up mental health interventions for depression and unhealthy alcohol use in Colombia. Rev Colomb Psiquiatr (Engl Ed) 2021; 50 Suppl 1:1-3. [PMID: 34253501 DOI: 10.1016/j.rcpeng.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Carlos Gómez-Restrepo
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia; Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá DC, Colombia; Hospital Universitario San Ignacio, Bogotá DC, Colombia.
| | - Lisa A Marsch
- Investigadora Principal, Director Center for Technology and Behavioral Health, Andrew G. Wallace Professor, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States
| |
Collapse
|
36
|
Gómez-Restrepo C, Cepeda M, Torrey W, Castro S, Uribe-Restrepo JM, Suárez-Obando F, Marsch LA. The DIADA project: A technology-based model of care for depression and risky alcohol use in primary care centres in Colombia. Rev Colomb Psiquiatr (Engl Ed) 2021; 50 Suppl 1:4-12. [PMID: 34244120 DOI: 10.1016/j.rcpeng.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION People with mental health conditions frequently attend primary care centers, but these conditions are underdiagnosed and undertreated. The objective of this paper is to describe the model and the findings of the implementation of a technology-based model of care for depression and unhealthy alcohol use in primary care centers in Colombia. METHODS Between February 2018 and March 2020, we implemented a technology-based model of care for depression and unhealthy alcohol use, following a modified stepped wedge methodology, in six urban and rural primary care centers in Colombia. The model included a series of steps aimed at screening patients attending medical appointments with general practitioners and supporting the diagnosis and treatment given by the general practitioner. We describe the model, its implementation and the characteristics of the screened and assessed patients. RESULTS During the implementation period, we conducted 22,354 screenings among 16,188 patients. The observed rate of general practitioner (GP)-confirmed depression diagnosis was 10.1% and of GP-confirmed diagnosis of unhealthy alcohol use was 1.3%. Patients with a depression diagnosis were primarily middle-aged women, while patients with unhealthy alcohol use were mainly young adult men. DISCUSSION The provision of training and technology-based strategies to screen patients and support the decision-making of GPs during the medical appointment enhanced the diagnosis and care provision of patients with depression and unhealthy alcohol use. However, time constraints, as well as structural and cultural barriers, were challenges for the implementation of the model, and the model should take into account local values, policies and resources to guarantee its long-term sustainability. As such, the long-term sustainability of the model will depend on the alignment of different stakeholders, including decision-makers, institutions, insurers, GPs, patients and communities, to reduce the amount of patients seeking medical care whose mental health conditions remain undetected, and therefore untreated, and to ensure an appropriate response to the demand for mental healthcare that was revealed by the implementation of our model.
Collapse
Affiliation(s)
- Carlos Gómez-Restrepo
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, DC, Colombia; Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, DC, Colombia; Hospital Universitario San Ignacio, Bogotá, DC, Colombia.
| | - Magda Cepeda
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - William Torrey
- Department of Psychiatry, Dartmouth's Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States
| | - Sergio Castro
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - José Miguel Uribe-Restrepo
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - Fernando Suárez-Obando
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, DC, Colombia; Hospital Universitario San Ignacio, Bogotá, DC, Colombia
| | - Lisa A Marsch
- Department of Psychiatry, Dartmouth's Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States
| |
Collapse
|
37
|
Vargas S, Medina Chávez AM, Gómez-Restrepo C, Cárdenas P, Torrey WC, Williams MJ, Bartels SM, Cubillos L, Castro SM, Suárez-Obando F, Uribe-Restrepo JM, Marsch LA. Addressing harmful alcohol use in primary care in Colombia: Understanding the sociocultural context. Rev Colomb Psiquiatr (Engl Ed) 2021; 50 Suppl 1:73-82. [PMID: 34275776 PMCID: PMC8658746 DOI: 10.1016/j.rcpeng.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022]
Abstract
Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA, [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.
Collapse
Affiliation(s)
- Sebastián Vargas
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá DC, Colombia
| | - Ana María Medina Chávez
- Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia.
| | - Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá DC, Colombia; Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia; Hospital Universitario San Ignacio, Bogotá DC, Colombia
| | - Paula Cárdenas
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá DC, Colombia
| | - William C Torrey
- Departamento de Psiquiatría, Dartmouth's Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH, USA
| | - Makeda J Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Sophia M Bartels
- Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth College
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth College
| | - Sergio Mario Castro
- Departamento de Psiquiatría, Dartmouth's Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Fernando Suárez-Obando
- Departamento de Psiquiatría, Dartmouth's Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Instituto de Humana Genética, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia
| | - José M Uribe-Restrepo
- Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth College
| |
Collapse
|
38
|
Gómez-Restrepo C, Cárdenas P, Marroquín-Rivera A, Cepeda M, Suárez-Obando F, Miguel Uribe-Restrepo J, Castro S, Cubillos L, Torrey WC, Bartels SM, Van Arcken-Martínez C, Park S, John D, Marsch LA. Access barriers, self-recognition, and recognition of depression and unhealthy alcohol use: A qualitative study. Rev Colomb Psiquiatr (Engl Ed) 2021; 50 Suppl 1:52-63. [PMID: 34380593 PMCID: PMC8658748 DOI: 10.1016/j.rcpeng.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study. OBJECTIVES The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process. METHODS In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors. RESULTS We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions. CONCLUSIONS This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.
Collapse
Affiliation(s)
- Carlos Gómez-Restrepo
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia; Departmento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Paula Cárdenas
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Arturo Marroquín-Rivera
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José Miguel Uribe-Restrepo
- Departmento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Castro
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Cubillos
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, United States
| | - William C Torrey
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, United States
| | - Sophia M Bartels
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, United States
| | | | - Sena Park
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, United States
| | - Deepak John
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, United States
| | - Lisa A Marsch
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, United States
| |
Collapse
|
39
|
Jassir Acosta MP, Cárdenas Charry MP, Uribe Restrepo JM, Cepeda M, Cubillos L, Bartels SM, Castro S, Marsch LA, Gómez-Restrepo C. Characterizing the perceived stigma towards mental health in the early implementation of an integrated services model in primary care in Colombia. A qualitative analysis. Rev Colomb Psiquiatr (Engl Ed) 2021; 50 Suppl 1:91-101. [PMID: 34257054 PMCID: PMC8658752 DOI: 10.1016/j.rcpeng.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stigma is a sociocultural barrier to accessing mental health services and prevents individuals with mental health disorders from receiving mental health care. The Ministry of Health and Social Protection of Colombia acknowledges that a great number of people with mental disorders do not seek medical aid due to stigma. OBJECTIVES Characterise the perceived stigma towards mental health among the stakeholders involved in the early implementation of the DIADA project [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)]. Explore whether the implementation of this model can decrease stigma. Describe the impact of the implementation on the lives of patients and medical practice. MATERIALS AND METHODS Eighteen stakeholders (7 patients, 5 physicians and 6 administrative staff) were interviewed and a secondary data analysis of 24 interview transcripts was conducted using a rapid analysis technique. RESULTS The main effects of stigma towards mental health disorders included refusing medical attention, ignoring illness, shame and labelling. Half of the stakeholders reported that the implementation of mental health care in primary care could decrease stigma. All of the stakeholders said that the implementation had a positive impact. CONCLUSIONS The perceived stigma was characterised as social and aesthetic in nature. Communication and awareness about mental health is improving, which could facilitate access to mental health treatment and strengthen the doctor-patient relationship. Culture is important for understanding stigma towards mental health in the population studied.
Collapse
Affiliation(s)
| | | | | | - Magda Cepeda
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Sophie M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | |
Collapse
|
40
|
Cárdenas Charry MP, Jassir Acosta MP, Uribe Restrepo JM, Cepeda M, Martinez Camblor P, Cubillos L, Bartels SM, Castro S, Marsch LA, Gómez-Restrepo C. Relationship between the sociodemographic characteristics of participants in the DIADA project and the rate of compliance with follow-up assessments in the initial stage of the intervention. Rev Colomb Psiquiatr (Engl Ed) 2021; 50 Suppl 1:102-109. [PMID: 34301528 PMCID: PMC8658751 DOI: 10.1016/j.rcpeng.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Analyse the relationship between the sociodemographic profile of the DIADA study participants and the rate of compliance with the follow-up assessments in the early stage of this project's intervention for depression and unhealthy alcohol use offered within primary care. METHODS A non-experimental quantitative analysis was conducted. The sociodemographic data of DIADA [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)] study participants had been previously collected. At the time of the evaluation (September 12, 2019), only the participants who had been in the project for a minimum of 3 months were included. By using univariate (Chi-squared) analyses, we studied the association between participants' sociodemographic profile and their rate of compliance with the first follow-up assessment at 3 months after study initiation. RESULTS At the date of the evaluation, 584 adult participants were identified, of which 389 had been involved in the project for more than 3 months. From the participants included, 320 performed the first follow-up, while 69 did not. The compliance rate to the first follow-up was 82.3% (95 % [CI] 78.1%-86%) and was not affected by: site location, age, sex, civil status, level of education, use of smartphone, PHQ9 score (measuring depression symptomatology) or AUDIT score (measuring harmful alcohol use). Participants who do not use a smartphone, from rural areas and with a lower socioeconomic status, tended to show higher compliance rates. Statistically significant associations were found; participants with lower job stability and a lack of access to the Internet showed higher compliance rates to the early initial follow-up assessment. CONCLUSIONS The compliance rate was high and generally constant in spite of the variability of the sociodemographic profiles of the participants, although several sub-groups of participants showed particularly high rates of compliance. These findings may suggest that integrating mental health into primary care allows the structural and financial barriers that hinder access to health in Colombia to be broken down by raising awareness about mental illnesses, their high prevalence and the importance of timely and accessible medical management.
Collapse
Affiliation(s)
- María Paula Cárdenas Charry
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Maria Paula Jassir Acosta
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José Miguel Uribe Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martinez Camblor
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, United States of America
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, United States of America
| | - Sophia M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, United States of America
| | - Sergio Castro
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, United States of America
| | - Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
| |
Collapse
|
41
|
Cavazos-Rehg PA, Krauss MJ, Costello SJ, Ramsey AT, Petkas D, Gunderson S, Bierut LJ, Marsch LA. Delivering information about medication assisted treatment to individuals who misuse opioids through a mobile app: a pilot study. J Public Health (Oxf) 2021; 42:149-154. [PMID: 30445639 DOI: 10.1093/pubmed/fdy207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/19/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Digital therapeutic tools (e.g. mobile applications) can be accessible, low-cost interventions that counter misconceptions about medication assisted treatment (MAT) and/or improve deficits in MAT knowledge that are common barriers to treatment entry among individuals with opioid dependence. The purpose of this pilot study was to examine the preliminary effectiveness of a mobile application, 'uMAT-R', that includes health information about OUD recovery supported by science and MAT benefits. METHODS Twenty-six adult participants with OUD recruited via social media completed all modules and pre/post-assessments within uMAT-R. McNemar's test was used to compare interest in treatment before and after completing the app, and paired t tests were used to compare MAT attitude scores before and after completing the modules within uMAT-R. RESULTS Before viewing uMAT-R, 32% agreed/strongly agreed that they were interested in starting treatment to recover from opioid misuse, compared to 48% after completing uMAT-R. The average scores on the MAT attitudes scale and its Aid to Behavior Change subscale improved from before to after viewing uMAT-R. Among the participants, 88% felt that uMAT-R would be useful to consult when making decisions about recovery. CONCLUSIONS Our encouraging pilot findings support the use of uMAT-R to help address the current opioid epidemic.
Collapse
Affiliation(s)
- Patricia A Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA
| | - Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA
| | - Shaina J Costello
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA
| | - Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA
| | - Demetrie Petkas
- iTether Technologies, 1300 East Missouri Avenue, Suite 100, Phoenix, AZ,USA
| | - Sean Gunderson
- iTether Technologies, 1300 East Missouri Avenue, Suite 100, Phoenix, AZ,USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, USA
| | - Lisa A Marsch
- Department of Psychiatry, Dartmouth College, Hanover, NH, USA
| |
Collapse
|
42
|
Aronson ID, Zhang J, Rajan S, Bugaighis M, Marsch LA, Ibitoye M, Chernick LS, Des Jarlais DC. Mobile Augmented Screening to Increase HIV Testing Among Emergency Department Patients as Young as 13 Years. Cureus 2021; 13:e15829. [PMID: 34327070 PMCID: PMC8301293 DOI: 10.7759/cureus.15829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
Abstract
Because adolescents and emerging adults are frequently not offered HIV testing, and often decline tests when offered, we developed and tested a tablet-based intervention to increase HIV test rates among emergency department (ED) patients aged 13-24 years. Pediatric and adult ED patients in a high volume New York City hospital (N = 295) were randomized to receive a face-to-face HIV test offer, or to complete a tablet-based intervention that contained an HIV test offer delivered via computer. Test rates in both conditions were then compared to historic test rates in the same ED during the previous six months. Among participants aged 19 years and younger who were offered HIV testing and declined before enrollment in the study, participants in the tablet-based condition were 1.7 times more likely to test for HIV compared to participants in the face-to-face condition. Participants aged 19 years and younger were three times as likely to test for HIV compared to patients the same age who were treated in the previous six months (26.39%, n = 71 study participants vs. 10.29%, n = 189 prior patients, OR = 3.13, \begin{document}\chi\end{document}2 = 54.76, p < 0.001). Protocols designed to offer HIV testing to all eligible patients can significantly increase adolescent test rates compared to standard practice. Because tablets are equally effective compared to face-to-face offers, and in some cases more so, EDs may consider tablet-based interventions that require fewer staff resources and may integrate more easily into high-volume workflows.
Collapse
Affiliation(s)
- Ian D Aronson
- Research, Digital Health Empowerment, Brooklyn, USA.,Social and Behavioral Sciences, New York University School of Global Public Health, New York, USA
| | - Jingru Zhang
- Measurement and Evaluation, Teachers College, Columbia University, New York, USA
| | - Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, USA
| | - Mona Bugaighis
- Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, USA
| | - Mobolaji Ibitoye
- Institute for Population Research, The Ohio State University, Columbus, USA
| | - Lauren S Chernick
- Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Don C Des Jarlais
- Epidemiology, New York University School of Global Public Health, New York, USA
| |
Collapse
|
43
|
Gómez-Restrepo C, Cárdenas P, Marroquín-Rivera A, Cepeda M, Suárez-Obando F, Uribe-Restrepo JM, Castro S, Cubillos L, Torrey WC, Bartels SM, Van Arcken-Martínez C, Park S, John D, Marsch LA. Access barriers, self-recognition, and recognition of depression and unhealthy alcohol use: A qualitative study. ACTA ACUST UNITED AC 2021. [PMID: 33992431 DOI: 10.1016/j.rcp.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study. OBJECTIVES The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process. METHODS In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors. RESULTS We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions. CONCLUSIONS This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.
Collapse
Affiliation(s)
- Carlos Gómez-Restrepo
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia; Departmento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá DC, Colombia.
| | - Paula Cárdenas
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Arturo Marroquín-Rivera
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José Miguel Uribe-Restrepo
- Departmento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Castro
- Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Cubillos
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, Estados Unidos
| | - William C Torrey
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, Estados Unidos
| | - Sophia M Bartels
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, Estados Unidos
| | | | - Sena Park
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, Estados Unidos
| | - Deepak John
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, Estados Unidos
| | - Lisa A Marsch
- Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, Estados Unidos
| |
Collapse
|
44
|
Escobar-Viera CG, Cernuzzi LC, Miller RS, Rodríguez-Marín HJ, Vieta E, González Toñánez M, Marsch LA, Hidalgo-Mazzei D. Feasibility of mHealth interventions for depressive symptoms in Latin America: a systematic review. Int Rev Psychiatry 2021; 33:300-311. [PMID: 34102945 PMCID: PMC8318676 DOI: 10.1080/09540261.2021.1887822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Depression is a prevalent disorder and leading cause of disability in Latin America, where the mental health treatment gap is still above 50%. We sought to synthesise and assess the quality of the evidence on the feasibility of mHealth-based interventions for depression in Latin America. We conducted a literature search of studies published in 2007 and after using four electronic databases. We included peer-reviewed articles, in English, Spanish or Portuguese, that evaluated interventions for depressive symptoms. Two authors independently extracted data using forms developed a priori. We assessed appropriateness of reporting utilising the CONSORT checklist for feasibility trials. Eight manuscripts were included for full data extraction. Appropriate reporting varied greatly. Most (n = 6, 75%) of studies were conducted in primary care settings and sought to deliver psychoeducation or behaviour change interventions for depressive symptoms. We found great heterogeneity in the assessment of feasibility. Two studies used comparator conditions. mHealth research for depression in Latin America is scarce. Included studies showed some feasibility despite methodological inconsistencies. Given the dire need for evidence-based mental health interventions in this region, governments and stakeholders must continue promoting and funding research tailored to cultural and population characteristics with subsequent pragmatic clinical trials.
Collapse
Affiliation(s)
- César G. Escobar-Viera
- Center for Research on Behavioral Health, Media, and Technology, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luca C. Cernuzzi
- Facultad de Ciencias y Tecnología, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Rebekah S. Miller
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hugo J. Rodríguez-Marín
- Dirección de Salud Mental, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay;,Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Magalí González Toñánez
- Facultad de Ciencias y Tecnología, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| |
Collapse
|
45
|
Hser YI, Ober AJ, Dopp AR, Lin C, Osterhage KP, Clingan SE, Mooney LJ, Curtis ME, Marsch LA, McLeman B, Hichborn E, Lester LS, Baldwin LM, Liu Y, Jacobs P, Saxon AJ. Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial. Addict Sci Clin Pract 2021; 16:24. [PMID: 33879260 PMCID: PMC8056373 DOI: 10.1186/s13722-021-00233-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/09/2021] [Indexed: 11/14/2022] Open
Abstract
Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.
Collapse
Affiliation(s)
- Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
| | | | | | - Chunqing Lin
- Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California At Los Angeles, Los Angeles, CA, USA
| | - Katie P Osterhage
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Megan E Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Emily Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Laurie S Lester
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Yanping Liu
- Center for Clinical Trials Network, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
46
|
McCormack RP, Rotrosen J, Gauthier P, D'Onofrio G, Fiellin DA, Marsch LA, Novo P, Liu D, Edelman EJ, Farkas S, Matthews AG, Mulatya C, Salazar D, Wolff J, Knight R, Goodman W, Hawk K. Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study. Addict Sci Clin Pract 2021; 16:16. [PMID: 33750454 PMCID: PMC7941881 DOI: 10.1186/s13722-021-00224-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/20/2021] [Indexed: 02/02/2023] Open
Abstract
Background For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study, its rapid funding mechanism, and accelerated timeline originated out of the urgent need to learn whether ED-initiated buprenorphine (BUP) with referral for treatment of OUD is generalizable, as well as to develop strategies to facilitate its adoption across a variety of ED settings and under real-world conditions. It both complements and uses methods adapted from Project ED Health (CTN-0069), a Hybrid Type 3 implementation-effectiveness study of using Implementation Facilitation (IF) to integrate ED-initiated BUP and referral programs. Methods ED-CONNECT (CTN 0079) was a three-site implementation study exploring the feasibility, acceptability, and impact of introducing ED-initiated BUP in rural and urban settings with high-need, limited resources, and different staffing structures. We used a multi-faceted approach to develop, introduce and iteratively refine site-specific ED clinical protocols and implementation plans for opioid use disorder (OUD) screening, ED-initiated BUP, and referral for treatment. We employed a participatory action research approach and use mixed methods incorporating data derived from abstraction of medical records and administrative data, assessments of recruited ED patient-participants, and both qualitative and quantitative inquiry involving staff from the ED and community, patients, and other stakeholders. Discussion This study was designed to provide the necessary, time-sensitive understanding of how to identify OUD and initiate treatment with BUP in the EDs previously not providing ED-initiated BUP, in communities in which this intervention is most needed: high need, low resource settings. Trial registration: The study was prospectively registered on ClinicalTrials.gov (NCT03544112) on June 01, 2018: https://clinicaltrials.gov/ct2/show/NCT03544112.
Collapse
Affiliation(s)
- Ryan P McCormack
- New York University Grossman School of Medicine, 227 E 30th St, Ground Floor, EM Research, New York, NY, 10016, USA.
| | - John Rotrosen
- New York University Grossman School of Medicine, 227 E 30th St, Ground Floor, EM Research, New York, NY, 10016, USA
| | - Phoebe Gauthier
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David A Fiellin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lisa A Marsch
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Patricia Novo
- New York University Grossman School of Medicine, 227 E 30th St, Ground Floor, EM Research, New York, NY, 10016, USA
| | - David Liu
- National Institute on Drug Abuse, Rockville, MD, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sarah Farkas
- New York University Grossman School of Medicine, 227 E 30th St, Ground Floor, EM Research, New York, NY, 10016, USA
| | | | | | | | | | | | | | - Kathryn Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
47
|
Marsch LA, Moore SK, Grabinski M, Bessen SY, Borodovsky J, Scherer E. Evaluating the Effectiveness of a Web-Based Program (POP4Teens) to Prevent Prescription Opioid Misuse Among Adolescents: Randomized Controlled Trial. JMIR Public Health Surveill 2021; 7:e18487. [PMID: 33629961 PMCID: PMC8128362 DOI: 10.2196/18487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background Prescription opioid (PO) use is common among adolescents in the United States. Despite recent declines from unprecedented peaks in adolescent PO use (eg, in 2012-2013), there is seemingly paradoxical evidence that PO-related consequences (eg, opioid use disorder and overdoses) are increasing. These trends and their possible consequences emphasize the importance of prevention efforts targeting PO misuse. To our knowledge, we have developed the first interactive web-based program (POP4Teens [P4T]) focused specifically on the prevention of PO misuse among adolescents. Objective This study aimed to evaluate the effectiveness of P4T, a web-based program designed to prevent adolescent PO misuse, in comparison with JustThinkTwice (JTT), an active control website, on PO-related attitudes, knowledge, risk perception, and intentions to use. Methods We conducted a web-based randomized controlled trial in 2018. A total of 406 adolescents (aged 12-17 years) were randomly assigned to either P4T or JTT. The outcome variables were attitudes, knowledge, and risk perceptions associated with PO misuse, intentions to use POs, and program feedback. Data were collected at baseline and at 1, 3, and 6 months. Results Both programs resulted in significant and sustained improvements in intention to use POs, increased perceived risk, impacted expectancies consistent with prevention, and improved PO refusal skills. P4T produced significantly greater increases in PO-related knowledge than JTT did, and it was reportedly easier to use and more liked. Baseline scores for youth reporting past-year medical use of POs, friends who engage in nonmedical use of POs, and/or poor mental health underscored their at-risk status compared with youth from the other groups. Conclusions P4T positively impacted all study variables that are known to prevent PO misuse among teens. Moreover, its web-based nature simplifies the dissemination and implementation of this novel tool designed to help meet the challenges of the evolving national opioid crisis. Trial Registration ClinicalTrials.gov NCT02737696; https://clinicaltrials.gov/ct2/show/NCT02737696
Collapse
Affiliation(s)
- Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,HealthSim Inc, Hanover, NH, United States.,Square2 Systems, Inc, Hanover, NH, United States
| | - Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Michael Grabinski
- HealthSim Inc, Hanover, NH, United States.,Square2 Systems, Inc, Hanover, NH, United States
| | - Sarah Y Bessen
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Emily Scherer
- Department of Biomedical Data Science, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
48
|
Cubillos L, Bartels SM, Torrey WC, Naslund J, Uribe-Restrepo JM, Gaviola C, Díaz SC, John DT, Williams MJ, Cepeda M, Gómez-Restrepo C, Marsch LA. The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries: systematic review. BJPsych Bull 2021; 45:40-52. [PMID: 32321610 PMCID: PMC8058938 DOI: 10.1192/bjb.2020.35] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries. RESULTS Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models. CLINICAL IMPLICATIONS Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
Collapse
Affiliation(s)
- Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Sophia M. Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
| | - William C. Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, USA
| | - John Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, USA
| | | | - Chelsea Gaviola
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
| | - Sergio Castro Díaz
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Colombia
| | - Deepak T. John
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
| | - Makeda J. Williams
- Center for Global Mental Health Research, National Institute of Mental Health, USA
| | - Magda Cepeda
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Colombia
| | - Carlos Gómez-Restrepo
- Department of Psychiatry and Mental Health, Pontificia Universidad Javeriana, Colombia
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Colombia
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, USA
| |
Collapse
|
49
|
Maricich YA, Bickel WK, Marsch LA, Gatchalian K, Botbyl J, Luderer HF. Safety and efficacy of a prescription digital therapeutic as an adjunct to buprenorphine for treatment of opioid use disorder. Curr Med Res Opin 2021; 37:167-173. [PMID: 33140994 PMCID: PMC8666102 DOI: 10.1080/03007995.2020.1846022] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of a digital therapeutic in treatment-seeking individuals with opioid use disorder (OUD) in an analysis of randomized clinical trial (RCT) data (ClinicalTrials.gov identifier: NCT00929253). METHODS Secondary analysis of an RCT including 170 adults meeting DSM-IV criteria for OUD. Participants were randomized to 12-weeks of treatment-as-usual (TAU) or TAU plus a digital therapeutic providing 67 digital, interactive educational modules based on the Community Reinforcement Approach. TAU consisted of buprenorphine maintenance therapy, 30 min biweekly clinician interaction, and abstinence-based contingency management. Primary endpoints were treatment retention and abstinence (negative urine drug screen) during weeks 9-12 of treatment. Safety was assessed by evaluating adverse events. RESULTS Participants randomized to TAU plus a digital therapeutic had significantly greater odds of opioid abstinence during weeks 9-12 compared to TAU: 77.3 versus 62.1%, respectively (p=.02), OR 2.08, 95% CI 1.10-3.95. The risk of patients leaving treatment was significantly lower in the digital therapeutic group (HR 0.49, 95% CI 0.26-0.92). No significant difference was observed in the rate of adverse events between groups (p=.42). CONCLUSIONS A prescription digital therapeutic (PDT) in combination with buprenorphine therapy improves clinically significant patient outcomes including abstinence from illicit opioids and retention in treatment compared with treatment as usual.
Collapse
Affiliation(s)
| | | | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | | | | | | |
Collapse
|
50
|
Lord SE, Campbell ANC, Brunette MF, Cubillos L, Bartels SM, Torrey WC, Olson AL, Chapman SH, Batsis JA, Polsky D, Nunes EV, Seavey KM, Marsch LA. Workshop on Implementation Science and Digital Therapeutics for Behavioral Health. JMIR Ment Health 2021; 8:e17662. [PMID: 33507151 PMCID: PMC7878106 DOI: 10.2196/17662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022] Open
Abstract
Digital therapeutics can overcome many of the barriers to translation of evidence-based treatment for substance use, mental health, and other behavioral health conditions. Delivered via nearly ubiquitous platforms such as the web, smartphone applications, text messaging, and videoconferencing, digital therapeutics can transcend the time and geographic boundaries of traditional clinical settings so that individuals can access care when and where they need it. There is strong empirical support for digital therapeutic approaches for behavioral health, yet implementation science with regard to scaling use of digital therapeutics for behavioral health is still in its early stages. In this paper, we summarize the proceedings of a day-long workshop, "Implementation Science and Digital Therapeutics," sponsored and hosted by the Center for Technology and Behavioral Health at Dartmouth College. The Center for Technology and Behavioral Health is an interdisciplinary P30 Center of Excellence funded by the National Institute on Drug Abuse, with the mission of promoting state-of-the-technology and state-of-the-science for the development, evaluation, and sustainable implementation of digital therapeutic approaches for substance use and related conditions. Workshop presentations were grounded in current models of implementation science. Directions and opportunities for collaborative implementation science research to promote broad adoption of digital therapeutics for behavioral health are offered.
Collapse
Affiliation(s)
- Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Mary F Brunette
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Sophia M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - William C Torrey
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Ardis L Olson
- Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Steven H Chapman
- Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - John A Batsis
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States
| | - Daniel Polsky
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Edward V Nunes
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Katherine M Seavey
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States
| |
Collapse
|