Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study

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.

The Relationship Between Emerging Adult Alcohol Consumption and Military Enlistment

BACKGROUND

The use and abuse of alcohol among active duty personnel is well documented in the research literature. Over the last decade rates of heavy and excessive drinking within the military have increased significantly, coinciding with both Operation Enduring Freedom and Operation Iraqi Freedom. The heavy use of alcohol by military personnel can be attributed to multiple factors such as the psychosocial and environmental stressors of military life and is frequently linked to mental health issues, the transient nature of the armed forces, the number and length of deployments, and exposure to life-threatening situations in combat environments. However, it is also likely rates of heavy alcohol use in the military are influenced by the possibility that individuals who already drink heavily choose to enlist in the armed services. The purpose of the present study was to test the association between drinking in emerging adulthood and military enlistment in a nationally representative sample of participants.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we tested the relationship between alcohol consumption in emerging adulthood and military enlistment in a sample of young adults ages 24 to 32 (n = 12,288). Results were stratified for men and women.

FINDINGS

Results of the multivariate logistic regression models stratified by gender indicated male participants who reported consuming alcohol in the past year were more likely to join the military relative to nondrinkers after controlling for respondent age, race, and education. There were no significant associations between alcohol consumption and military enlistment for women.

DISCUSSION

These findings demonstrate limited support for a relationship between alcohol consumption and military service. For men who drink, choosing military service may be influenced by the culture of drinking within the armed services. However, given the limited support found in the present study for a link between drinking in emerging adulthood and military service, the current high use of alcohol among active duty personnel is likely influenced by socialization processes within the military as well as from the stress of increased deployments to life-threatening combat situations. These results have important implications for informing policy and prevention programs within the armed services to improve both the short-term and long-term success of military service members.

Designing messaging to engage patients in an online suicide prevention intervention: survey results from patients with current suicidal ideation

Background

Computerized, Internet-delivered interventions can be efficacious; however, uptake and maintaining sustained client engagement are still big challenges. We see the development of effective engagement strategies as the next frontier in online health interventions, an area where much creative research has begun. We also argue that for engagement strategies to accomplish their purpose with novel targeted populations, they need to be tailored to such populations (ie, content is designed with the target population in mind). User-centered design frameworks provide a theoretical foundation for increasing user engagement and uptake by including users in development. However, deciding how to implement this approach to enage users in mental health intervention development is challenging.

Objective

The aim of this study was to get user input and feedback on acceptability of messaging content intended to engage suicidal individuals.

Methods

In March 2013, clinic intake staff distributed flyers announcing the study, “Your Feedback Counts” to potential participants (individuals waiting to be seen for a mental health appointment) together with the Patient Health Questionnaire. The flyer explained that a score of two or three (“more than half the days” or “nearly every day” respectively) on the suicide ideation question made them eligible to provide feedback on components of a suicide prevention intervention under development. The patient could access an anonymous online survey by following a link. After providing consent online, participants completed the anonymous survey.

Results

Thirty-four individuals provided data on past demographic information. Participants reported that they would be most drawn to an intervention where they knew that they were cared about, that was personalized, that others like them had found it helpful, and that included examples with real people. Participants preferred email invitations with subject lines expressing concern and availability of extra resources. Participants also provided feedback about a media prototype including a brand design and advertisement video for introducing the intervention.

Conclusions

This paper provides one model (including development of an engagement survey, audience for an engagement survey, methods for presenting results of an engagement survey) for including target users in the development of uptake strategies for online mental health interventions.