Telehealth to improve continuity for patients receiving buprenorphine treatment for opioid use disorder

Context

Buprenorphine is medication-assisted treatment for opioid use disorder. It is a controlled substance and most states limit the dispensing to a 30-day supply. Patients with opioid use disorder often have social determinants of health barriers that make it difficult to engage with the health system to obtain a new supply of buprenorphine every month. Telehealth can be used to reduce barriers to accessing care and improve continuity of care for patients receiving buprenorphine treatment.

Objective

To assess the rates of patient continuity for patients receiving buprenorphine treatment via tele-health versus in-person in a primary care outpatient setting.

Study Design

Review of patients receiving buprenorphine treatment for opioid use disorder and rates of continuity by visit type during a 2-year time period May 2019-May 2021.

Dataset

EPIC electronic medical records from an urban university-affiliated ambulatory primary care practice in New Jersey.

Population Studied

Patients scheduled for a visit in the outpatient primary care clinic. Approximately 69% were African American, 22% Hispanic, and 9% other. The majority were enrolled in Medicaid. 80% of patients faced one or more barriers to social determinants of health including transportation, housing, and economic stability.

Intervention

Establishment and implementation of HIPAA compliant tele-health following approved state guidelines for buprenorphine prescribing via tele-health. Appointments were scheduled in-person or tele-health by patients' preference.

Outcome Measures

Rates of continuity by visit type for patients receiving buprenorphine treatment during the study time period compared by chi-square.

Results

Of the 487 patients seen via tele-health, 297 (61%) continued to receive follow up care. Of the 811 patients seen in-person, 400 (49.3%) continued to receive follow up care, p<.0001. The patients who did not continue to receive follow up care were lost to follow up despite attempts to reach patients to re-engage in care.

Conclusions

Our study shows that rates of continuity of care are higher using tele-health for patients receiving medication assisted therapy for opioid use disorder. In an urban underserved population, tele-health can result in improved continuity of care for patients with opioid use disorder. Telehealth may reduce barriers to accessing care including transportation, work schedule, childcare, and other competing demands.

Best practices for collecting repeated measures data using text messages

Background

Researchers and clinicians use text messages to collect data with the advantage of real time capture when compared with standard data collection methods. This article reviews project setup and management for successfully collecting patient-reported data through text messages.

Methods

We review our experience enrolling over 2600 participants in six clinical trials that used text messages to relay information or collect data. We also reviewed the literature on text messages used for repeated data collection. We classify recommendations according to common themes: the text message, the data submitted and the phone used.

Results

We present lessons learned and discuss how to create text message content, select a data collection platform with practical features, manage the data thoughtfully and consistently, and work with patients, participants and their phones to protect privacy. Researchers and clinicians should design text messages to include short, simple prompts and answer choices. They should decide whether and when to send reminders if participants do not respond and set parameters regarding when and how often to contact patients for missing data. Data collection platforms send, receive, and store messages. They can validate responses and send error messages. Researchers should develop a protocol to append and correct data in order to improve consistency with data handling. At the time of enrollment, researchers should ensure that participants can receive and respond to messages. Researchers should address privacy concerns and plan for service interruptions by obtaining alternate participant contact information and providing participants with a backup data collection method.

Conclusions

Careful planning and execution can reward clinicians and investigators with complete, timely and accurate data sets.

Bleeding and spotting with the levonorgestrel 13.5 mg intrauterine system: the impact of insertion timing

OBJECTIVE

To assess the impact of early versus late menstrual cycle insertion on bleeding/spotting in the 90 days following levonorgestrel (LNG) 13.5 mg intrauterine system (IUS) insertion.

STUDY DESIGN

In this observational study, participants received a LNG 13.5 mg IUS and provided 90 days of bleeding/spotting data by answering the following daily text: "Have you had no flow (0), spotting (1), or bleeding (2) today?" We dichotomized insertion timing as early (days 1-7 from last menstrual period) and late (remainder of menstrual cycle) and compared bleeding/spotting between the two groups in the 90- and 30-day reference periods. We used multivariate regression methods to study associations between cycle day at insertion, parity, historical bleeding, recent hormonal contraceptive use and bleeding/spotting.

RESULTS

In the 90-day dichotomous analysis (n=125), we found no differences in the number of days of bleeding/spotting, bleeding or spotting between the early and late insertion groups. In the 30-day dichotomous analysis (n=131), early insertion was associated with fewer days of bleeding than late insertion (5±3 vs. 7±4 days, p<.01). Recent hormonal contraceptive users experienced fewer days of bleeding than new users (5±4 vs. 7±3 days, p<.01). In the 90- and 30-day regression models, earlier insertion was associated with fewer days of bleeding (p=.02, p=.02). Recent contraceptive use was associated with fewer days of bleeding/spotting (90-day, p=.03) and fewer days of bleeding (30-day, p<.01). Nulliparity was associated with spotting (30-day, p=.04).

CONCLUSIONS

Early cycle insertion does not impact 90-day bleeding/spotting. Early cycle insertion and recent hormonal contraceptive use decrease 30-day bleeding.

IMPLICATIONS

The LNG 13.5 mg IUS may be inserted throughout the menstrual cycle with small differences in bleeding patterns in the 30 but not the 90 days following insertion. Shared decision making should determine timing of insertion.

Effect of gold adsorption on the conductive properties of cyclo-octasulfur microcrystals

The formation of gold crystallites on the surface of S8 promotes diffusion of electrons and determines the conductive properties of the shell-core nanosystems. Conducting probe atomic microscopy and four-probe resistance measurements confirmed that Au/S8 shell-core systems exhibit electrical conductivity on the micro- as well as on the nanoscale in contrast to non-covered S8 crystals, which are insulating. The conductivity of Au/S8 systems on the microscale was measured to be 10+/-1 S cm(-1). In XPS measurements, a single peak at 163.6 eV was observed for bulk S8 whereas an additional peak corresponding to a binding energy of 161.4 eV appeared for S8 adsorbed on a Au substrate. This is interpreted to mean that a chemical reaction has taken place. A process which results in adsorption of uniform gold nanolayers on needle shaped or fibrous S8 crystallites is under investigation.

Electrical-thermal switching in carbon-black-polymer composites as a local effect

Following the lack of microscopic information about the intriguing well-known electrical-thermal switching mechanism in carbon-black-polymer composites, we applied atomic force microscopy in order to reveal the local nature of the process and correlated it with the characteristics of the widely used commercial switches. We conclude that the switching events take place in critical interparticle tunneling junctions that carry most of the current. The macroscopic switched state is then a result of a dynamic-stationary state of fast switching and slow reconnection of the corresponding junctions.

Prophylaxis provided to sexual assault victims seen at US emergency departments

OBJECTIVE

to report on prophylaxis provided to victims of sexual assault seen at hospital emergency departments in the United States.

METHODS

Secondary analysis was performed on data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for 1994 to 1999. NHAMCS is a national probability sample of patient visits to US hospital emergency departments. Cases of sexual assault were identified using reason for visit, diagnostic, and injury codes. The medications provided for each case were examined.

RESULTS

We identified 160 cases of sexual assault from 137 822 emergency department visits. None of these victims received the full regimen of antibiotics for sexually transmitted infections (STIs) recommended by the Centers for Disease Control and Prevention. Antibiotics for gonorrhea and chlamydia, 2 of the more frequently diagnosed STIs, were provided for only 24.8% of adults and adolescents. No antibiotics were ordered in 62.5% of all cases or in 51.3% of cases of patients 12 years and older. Twenty-one percent of those eligible received emergency contraception. Human immunodeficiency virus prophylaxis was amongthe medications ordered in one 1999 case. Roughly estimated, more than 60000 victims of sexual assault who visit US emergency departments annually may not be offered antibiotic treatment for the prevention of STIs.

CONCLUSION

Even when data limitations are taken into account, our results suggest that emergency department staff may not be routinely providing antibiotic therapy for the prevention of STIs or emergency contraception to victims of sexual assault. A comprehensive national standard of care is needed for the medical treatment of victims of sexual assault along with more training for health care providers.

Inactivation of olfactory sensilla of a single morphological type differentially affects the response of Drosophila to odors

The olfactory organs on the head of Drosophila, antennae and maxillary palps, contain several hundred olfactory hairs, each with one or more olfactory receptor neurons. Olfactory hairs belong to one of three main morphological types, trichoid, basiconic, and coeloconic sensilla, and show characteristic spatial distribution patterns on the surface of the antenna and maxillary palps. Here we show that targeting expression of the cell-death gene reaper to basiconic sensilla (BS) causes the specific inactivation of most olfactory sensilla of this type with no detectable effect on other types of olfactory sensilla or the structure of the antennal lobe. Our data suggest that BS are required for a normal sensitivity to many odorants with a variety of chemical structures, through a wide range of concentrations. Interestingly, however, in contrast to other odorants tested, the behavioral response of ablated flies to intermediate concentrations of propionic and butyric acids is normal, suggesting the involvement of sensilla unaffected by ectopic reaper expression, probably coeloconic sensilla that respond strongly to these two organic acids. As inactivation of BS causes an underestimation of the concentration of both acids detectable at both the highest and lowest odorants concentrations, our results suggest that concentration coding for these two odorants relies on the integration of signals from different subsets of sensilla, most likely of different morphological types.

Cytokine-induced tumor immunogenicity: endogenous interleukin-1 alpha expressed by fibrosarcoma cells confers reduced tumorigenicity

A direct correlation between the constitutive expression of IL-1 alpha and reduced tumorigenicity of fibrosarcomas was observed. This was established in fibrosarcoma cell lines which produce IL-1 alpha 'spontaneously', possibly as an aberration of oncogene-mediated transformation or upon IL-1 alpha gene transfer. In fibroblasts intracellular or membrane-associated IL-1 alpha is expressed, whereas the secreted form of the cytokine (IL-1 beta) is absent. Studies on the mechanisms of tumor regression of the IL-1 alpha-positive fibroblastoid cell lines indicated that IL-1 alpha potentiates the development of tumor cell-specific CTLs, which are of importance for tumor eradication. Thus, IL-1 alpha induces enhanced helper T cell activity which provides auxiliary signals for the growth/development of CTLs. Non-adaptive effector cells, activated locally by IL-1 alpha-expressing fibrosarcoma cells, also contribute to the eradication of IL-1 alpha-expressing fibrosarcomas. Local IL-1 alpha expression potentiated antigen presentation, by the malignant fibroblasts as well as by tissue-resident antigen-presenting cells, thus further potentiating anti-tumor immune responses. Mice, in which IL-1 alpha-producing tumors were regressed, developed an immune memory and rejected a challenge with an IL-1 non-producing violent tumor cell line. Endogenous IL-1 alpha activates a cytokine cascade (i.e., IL-6, CSF), produced by the malignant cells and possibly also by stromal cells. However, IL-1 alpha expression is essential for fibrosarcoma eradication, while other cytokines possibly amplify and sustain its action.(ABSTRACT TRUNCATED AT 250 WORDS)