Hilllohmann7784
All respondents expressed support for making temporary regulatory flexibilities permanent, but differed in their implementation of the flexibilities and the extent to which they planned to modify their own practices long-term.
Findings support sustaining temporary regulatory and payment changes to MOUD practice, which may have improved treatment access and allowed for more flexible, individually tailored patient care. Few negative, unintended consequences were reported by providers, but more research is needed to evaluate the patient experience with changes to practice during the COVID-19 pandemic.
Findings support sustaining temporary regulatory and payment changes to MOUD practice, which may have improved treatment access and allowed for more flexible, individually tailored patient care. Few negative, unintended consequences were reported by providers, but more research is needed to evaluate the patient experience with changes to practice during the COVID-19 pandemic.
Suicidal ideation has increased among Latinx individuals in the last decade. Smoking increases the likelihood of suicidal ideation but work on Latinx smokers is minimal. Hazardous drinking and emotion dysregulation could be factors related to suicidal ideation among Latinx smokers, as has been evident in non-Latinx White samples. The current study sought to examine the main and interactive effects of emotion dysregulation and hazardous drinking in relation to suicidal ideation among Latinx daily-smokers.
Participants were 371 Spanish-speaking daily-smokers (58.8% female; M
=33.3; SD
=9.8) recruited from the United States through Qualtrics. We used structural equation modeling (SEM) to test an interactive model of emotion dysregulation and hazardous alcohol consumption in relation to suicidal ideation; we also tested the effect of emotion dysregulation on suicidal ideation as a function of hazardous drinking status.
Results indicated that latent emotional dysregulation was associated with greater suicid in relation to the potential role of intervention strategies that focus on emotion dysregulation and hazardous drinking among Latinx current daily smokers to mitigate suicidal risk among this established health disparities population.
Sequalae of opioid misuse constitute a public health emergency in the United States. A robust evidence base informs the use of medication for opioid use disorders (MOUD) in adults, with far less research in transition-age youth. This systematic review evaluates the effectiveness of MOUD for transition-age youth (age 16 to 25).
This synthesis was part of a larger systematic review focused on adolescent substance use interventions. The study team conducted literature searches in MEDLINE, the Cochrane CENTRAL Registry of Controlled Trials, EMBASE, PsycINFO, and CINAHL through October 31, 2019. We screened studies, extracted data, and assessed risk of bias using standard methods. The primary and secondary outcomes were the effect of MOUD on opioid abstinence and treatment retention, respectively.
The study team screened a total of 33,272 records and examined 1831 full-text articles. Four randomized trials met criteria for inclusion in the current analysis. All four trials assessed a combination of buprenorpliterature guiding youth MOUD is limited, and more research should evaluate the effectiveness of options other than buprenorphine, optimal treatment duration, and the benefit of adjunctive behavioral interventions. Subgroup analyses of extant randomized clinical trials could help to extend knowledge of MOUD effectiveness in this age cohort.
Patients' perceptions are vital to the delivery and evaluation of substance use treatment. They are most frequently collected at one time-point and measured using patient satisfaction questionnaires or qualitative methodologies. Interestingly, the findings of these studies often diverge, as satisfaction scores tend to be highly positive, while qualitative findings suggest dissatisfaction and areas for improvement. This divergence limits current understandings of patients' perceptions and their potential change over time in treatment.
This study explores the relationship between open-ended positive and negative perceptions of treatment and patient satisfaction scores over time.
The RUTH (Research on the Utilization of Therapeutic Hydromorphone) prospective cohort study included 131 participants receiving injectable diacetylmorphine or hydromorphone in Canada's first injectable opioid agonist treatment (iOAT) program. The study collected the Client Satisfaction Questionnaire (CSQ-8) at eight time-points onal growth curve models, the theme "unfavorable interactions with providers" had the strongest independent effect on overall satisfaction trajectories.
This study provides an example of how open-ended comments can be integrated with patient satisfaction questionnaire data to gather a comprehensive and patient-centered evaluation of substance use treatment. Considering the iOAT context specifically, relational dynamics and daily treatment access were significant predictors of patient satisfaction over time and may be attributes of iOAT that require further investigation.
This study provides an example of how open-ended comments can be integrated with patient satisfaction questionnaire data to gather a comprehensive and patient-centered evaluation of substance use treatment. Considering the iOAT context specifically, relational dynamics and daily treatment access were significant predictors of patient satisfaction over time and may be attributes of iOAT that require further investigation.
Alcohol and other drug (AOD) use problems may cause significant burden on affected adolescents and their families, yet treatment providers often do not identify these problems early enough.
To develop, and internally and externally validate a multivariable prediction model of adolescent AOD problems using child- and maternal-level predictors before age 12, and child-level predictors between ages 12 to 18, as recorded in the electronic health records (EHR).
A retrospective cohort study conducted time-to-event analyses using Cox proportional hazards models.
41,172 children born between 1997 and 2000 at four health plans (Kaiser Permanente Hawaii, KPHI; Kaiser Permanente Northern California, KPNC; Geisinger Clinic, GC; and Henry Ford Health System, HFHS) who had continuous membership since birth and linkable maternal records in the health plan.
AOD use problems between ages 12 to 18, defined as either 1) having a contact with the AOD treatment program or 2) receiving a non-tobacco AOD diagnosis in an ik of developing problems varies significantly by the timing and persistence of the risk factors. Findings may have potential clinical implications for prevention and identification of adolescent AOD problems, but more research is needed, especially across additional health systems.
This study identified a number of child and maternal characteristics and diagnoses routinely available in EHR data as predictive of risk for developing AOD problems in adolescence. Further, we found that risk of developing problems varies significantly by the timing and persistence of the risk factors. Findings may have potential clinical implications for prevention and identification of adolescent AOD problems, but more research is needed, especially across additional health systems.
Both public (government-run), and not-for-profit (nongovernment) service providers provide alcohol and other drug (AOD) treatment services. Research has rarely studied the structural features of these providers, such as workforce characteristics, procurement arrangements, and funding security. The study reported here sought to document and analyze the differences between these two AOD treatment provider types in Australia.
The study administered an online survey instrument targeted at managers of AOD treatment sites. The survey comprised three sections (1) the service (e.g., treatment types); (2) workforce (e.g., total number of staff); and (3) funding and procurement arrangements (e.g., contract length). The study completed a total of 207 site surveys. The studied compared government and nongovernment services on structural features that may create a more or less sustainable or vulnerable service (funding arrangements, payment mechanisms, and contract length).
Government providers were more likely to povernment service providers are essential.
Despite the reliance on NGOs to provide the majority of specialist care (71% of all treatment episodes in Australia), these services are more vulnerable than their government counterparts. To ensure that a comprehensive suite of treatment services is available, procurement arrangements that support stability and security in nongovernment service providers and government service providers are essential.
To assess the severity of methamphetamine use among methadone maintenance treatment (MMT) patients in Vietnam with opioid use disorder and concurrent methamphetamine use, and to identify risk factors associated with higher severity of methamphetamine use.
We used survey data and medical record abstractions from 428 people with opioid use disorder who also use methamphetamine while partaking in methadone treatment in five clinics in Hanoi, Vietnam. We used multinomial logistic regression to assess other risk factors and problems associated with high methamphetamine use severity.
Those who reported injecting heroin in the past 3months (AOR=4.05, 95% CI [1.30, 12.55], p=0.02), having a longer history of lifetime heroin use (AOR=1.13, 95% CI [1.03, 1.24], p<0.01), and having higher cravings (AOR=1.97, 95% CI [1.31, 2.98], p<0.01) and fatigue (AOR=1.25, 95% CI [0.96, 1.61], p=0.09) related to methamphetamine withdrawal had greater odds of high methamphetamine use severity. One of five clinics had a significantly higher percentage of methamphetamine use severity than others.
Successful MMT in patients with opioid use disorder in Vietnam may additionally require methamphetamine-focused screening and intervention.
Successful MMT in patients with opioid use disorder in Vietnam may additionally require methamphetamine-focused screening and intervention.
To evaluate associations between new types of buprenorphine waivers (nurse practitioner and physician assistant [NP/PA]; 275-patient limit [MD/DO-275]) and both buprenorphine prescribing and health outcomes.
Using comprehensive county-level data from California 2010-2018, we modeled quarterly associations between numbers of NP/PA and MD/DO-275 waivers and rates of buprenorphine prescribing, opioid-related deaths, emergency department (ED) visits, and hospitalizations among all counties and separately among metropolitan and nonmetropolitan counties using Poisson regression models with county and quarter fixed effects and adjusting for time-varying covariates.
Each additional NP/PA and MD/DO-275 waiver was associated with a 2.6% (95%CI 1.1-4.1%) and 5.8% (4.1-7.4%) increase in buprenorphine prescribing among nonmetropolitan counties, respectively. Each additional MD/DO-275 waiver was associated with a 2.8% (1.0%-4.6%) increase in buprenorphine among metropolitan counties. read more There were no statistically significant associations between NP/PA waivers and buprenorphine prescribing among metropolitan counties or among either waiver type and opioid-related health outcomes.
