scholarly journals Democratizing innovation through grass-roots entrepreneurship: lessons from efforts to address the opioid epidemic in the United States

2019 ◽  
Vol 4 (6) ◽  
pp. e002079
Author(s):  
Shriya Srinivasan ◽  
Khalil B. Ramadi ◽  
Andrea Ippolito ◽  
Rifat Atun
Keyword(s):  
Public Health ◽  
Design Thinking ◽  
The United States ◽  
Opioid Epidemic ◽  
Socioeconomic Indicators ◽  
Opioid Crisis ◽  
Health Initiatives ◽  
The Usa ◽  
Healthcare Innovation ◽  
Depressed Regions

The nationwide opioid epidemic has substantially impacted economically-depressed regions in the USA. Eastern Appalachia has some of the lowest socioeconomic indicators in the USA and has suffered the highest rate of opioid-related fatality in 2016. Despite devoting considerable federal and state resources towards public health initiatives, the region continued to experience one of the highest death rates and sought alternative approaches to address the opioid crisis. Here, we describe a community-based co-creation initiative that convened diverse sectors and utilised design thinking principles to generate sustainable public health ventures towards addressing the opioid crisis. Participants of diverse backgrounds came together to attack key challenges and developed and implemented solutions, including a mobile application for naloxone delivery and exercise programs for high schools to promote healthy habits. Grassroots innovation efforts catalysed by the event strengthened community engagement and facilitated a sense of agency among participants. Through specific examples of initiatives that were launched, we provide evidence to encourage and highlight the value of healthcare innovation efforts in low-resource settings.

scholarly journals Public health strategies to combat opioid epidemic in the United States: A systematic review

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
F Balidemaj
Keyword(s):  
Public Health ◽  
United States ◽  
Systematic Review ◽  
The United States ◽  
Opioid Abuse ◽  
Opioid Epidemic ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Opioid Crisis ◽  
Public Health Strategies

Abstract Background The opioid epidemic in the United States is a national public health crisis. Driven by an increase in availability of pharmaceutical opioids and by an increase in their consumption, specifically, for pain treatment, more so in the past twenty years, it has led to an economic cost of prescription opioid abuse, overdose, and dependence in the United States estimated to be 78.5 billion USD. The purpose of this systematic review was to identify and evaluate public health strategies that contribute towards combatting the opioid crisis. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a search was conducted of the PubMed database for articles in English language that analyzed the most effective ways to regulate health markets to decrease the opioid crisis in the United States. Results The initial search yielded 2397 titles, of which 15 full-text articles were ultimately selected for inclusion in this systematic review. The review identified four categories in overcoming this epidemic nationwide, including required improvement in patient utilization of and access to safe and effective treatment options for opioid abuse and overdose, addressing the stigma correlated with opioid use, considering appropriate use of abuse deterrent formulations (ADF) along with patient education, and improving prescribing practices via utilization of drug monitoring programs, CDC opioid prescribing guidelines and provider continuing education. Conclusions Attempts to combat the opioid epidemic have been made, and the state and federal governments have only recently started to understand the magnitude of the seriousness of this public health crisis. While the methods with promising improvement of the situation have been identified, implementing them has shown to be a challenge. Continued application is needed, while considering possible new steps that could help reinforce their utilization further. Key messages Attempts to combat the opioid epidemic have been made, and the state and federal governments have only recently started to understand the magnitude of the seriousness of this public health crisis. The methods with promising improvement of the opioid crisis situation have been identified, however utilizing and implementing the existing public health strategies has shown to be a challenge.

Physician Autonomy and the Opioid Crisis

2018 ◽  
Vol 46 (2) ◽  
pp. 203-219 ◽  
Author(s):  
Nathan Guevremont ◽  
Mark Barnes ◽  
Claudia E. Haupt
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Opioid Epidemic ◽  
Health Crisis ◽  
Physician Autonomy ◽  
Public Health Crisis ◽  
Opioid Crisis ◽  
Physician Relationship ◽  
Regulatory Regimes

The scope and severity of the opioid epidemic in the United States has prompted significant legislative intrusion into the patient-physician relationship. These proscriptive regulatory regimes mirror earlier legislation in other politically-charged domains like abortion and gun regulation. We draw on lessons from those contexts to argue that states should consider integrating their responses to the epidemic with existing medical regulatory structures, making physicians partners rather than adversaries in addressing this public health crisis.

scholarly journals Accountable Care Organizations and Clinical Commissioning Groups face an uncertain challenge for improving public health

2012 ◽  
Vol 1 (2) ◽  
pp. 16
Author(s):  
Douglas J. Noble
Keyword(s):  
Public Health ◽  
Health Services ◽  
Population Health ◽  
The United States ◽  
Accountable Care Organizations ◽  
Health Needs ◽  
Local Health ◽  
Accountable Care ◽  
The Usa ◽  
The Uk

<p>Accountable Care Organizations (ACO) in the United States of America (USA) and Clinical Commissioning Groups (CCG) in the United Kingdom (UK) are new proposed organizations in health services both tasked with a role which includes improving public health.  Although there are very significant differences between the UK and USA health systems there appears to be a similar confusion as to how ACO and CCG will regard and address public or population health.  The role of ACO in improving population health and evaluating the health needs of their registered and insured patients remains ill-defined and poorly explored.  Likewise, in the current UK National Health Service (NHS) reorganisation, control and commissioning of appropriate local health services are passing from Primary Care Trusts (PCT) to new cross-organizational structures (CCG).  CCG groups aim to be, like ACO, physician led.  They will also assume a role for public or population health, but this role, like that of the newly-forming ACO, is currently unclear.  Lessons learned from the USA and UK experience of new organizations tasked with a role in improving public health may inform mechanisms for physician led organizations in the UK and the USA to assess health needs, monitor population health information and improve population health outcomes.</p>

scholarly journals Addressing the Opioid Epidemic: Recommended Solutions from Physicians

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Jessica Cataldo ◽  
Sandra Collins ◽  
Richard C Mckinnies ◽  
Jane Nichols ◽  
Thomas A Shaw
Keyword(s):  
United States ◽  
Active Role ◽  
The United States ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Multifaceted Approach ◽  
Improve Treatment ◽  
Opioid Crisis ◽  
A Current

The purpose of this study was to assess physicians’ accounts related to the current opioid epidemic and to identify solutions that they feel would be most successful in addressing opioid misuse and overuse. A survey was administered a group of physicians obtained from a nationwide database. Nearly all physicians surveyed believed there was a current opioid crisis in the United States and that physicians should take an active role in addressing opioid use in patients. Four key themes emerged regarding solutions to the opioid crisis: i) policy change, ii) improve treatment, iii) education, and iv) alternative treatment. The diversity of responses highlighted the need for a multifaceted approach to address opioid misuse and abuse.

scholarly journals Responding to the Opioid Epidemic: Educational Competencies for Pain and Substance Use Disorder from the Medical Schools of the University of California

Pain Medicine ◽  
2020 ◽  
Author(s):  
Mark Servis ◽  
Scott M Fishman ◽  
Mark S Wallace ◽  
Stephen G Henry ◽  
Doug Ziedonis ◽  
...  
Keyword(s):  
Public Health ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Medical Schools ◽  
University Of California ◽  
Drug Misuse ◽  
Opioid Epidemic ◽  
Current Crisis ◽  
Opioid Crisis ◽  
The University

Abstract Objective The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD). Methods The six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic. The workgroup had diverse specialty and disciplinary representation. This workgroup focused on developing a foundational set of educational competencies for adoption across all UC medical schools that address pain, SUD, and public health concerns related to the opioid crisis. Results The UC pain and SUD competencies were either newly created or adapted from existing competencies that addressed pain, SUD, and opioid and other prescription drug misuse. The final competencies covered three domains: pain, SUD, and public health issues related to the opioid crisis. Conclusions The authors present a novel set of educational competencies as a response to the opioid crisis. These competencies emphasize the subject areas that are fundamental to the opioid crisis: pain management, the safe use of opioids, and understanding and treating SUD.

Health and Health Care Among Transgender Adults in the United States

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Ayden I. Scheim ◽  
Kellan E. Baker ◽  
Arjee J. Restar ◽  
Randall L. Sell
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Disparities ◽  
Access To Health Care ◽  
The United States ◽  
Social Contexts ◽  
Annual Review ◽  
Publication Date ◽  
Physical And Mental Health ◽  
The Usa

Transgender (trans) communities in the USA and globally have long organized for health and social equity but have only recently gained increased visibility within public health. In this review, we synthesize evidence demonstrating that trans adults in the USA are affected by disparities in physical and mental health and in access to health care, relative to cisgender (nontrans) persons. We draw on theory and data to situate these disparities in their social contexts, explicating the roles of gender affirmation, multilevel and intersectional stigmas, and public policies in reproducing or ameliorating trans health disparities. Until recently, trans health disparities were largely made invisible by exclusionary data collection practices. We highlight the importance of, and methodological considerations for, collecting inclusive sex and gender data. Moving forward, we recommend routine collection of gender identity data, an emphasis on intervention research to achieve trans health equity, public policy advocacy, and investment in supporting gender-diverse public health leadership. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Surveillance, Evaluation, and Research and the Opioid Epidemic

2019 ◽  
Author(s):  
Yngvild Olsen ◽  
Joshua M. Sharfstein
Keyword(s):  
United States ◽  
Life Expectancy ◽  
The United States ◽  
Opioid Epidemic ◽  
Opioid Crisis

How well is the United States tracking the opioid epidemic? Not well. For a threat that has cost tens of thousands of lives and reduced US life expectancy, the opioid crisis is not sufficiently monitored. Federal reports with data on the number of...

scholarly journals Twenty Years of Opioids Prescriptions in Spine Patients: The Experience of Two Academic Hospitals in Massachusetts

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Elisabetta Mezzalira ◽  
Paola Prieto Calvachi ◽  
Brittany M Stopa ◽  
Jordan Muse ◽  
Ahmad Kareem Almekkawi ◽  
...  
Keyword(s):  
The United States ◽  
Opioid Crisis ◽  
Medical Centers ◽  
Academic Medical ◽  
Academic Hospitals ◽  
Health Initiatives ◽  
Control And Prevention ◽  
Opioid Medications ◽  
New Evidence ◽  
Public Health Initiatives

Abstract INTRODUCTION There is an opioid crisis ongoing in the United States. Beginning in the 1990s, public campaigns aiming to increase pain awareness and new evidence claiming the safety of opioids to treat acute and chronic pain coincided with the heavy marketing of opioids, which led to an unprecedented opioid crisis. After the announcement of the opioid crisis in 2016, the Centers for Disease Control and Prevention (CDC) released new opioid-prescribing guidelines and the Comprehensive Addiction and Recovery Act was enacted. The objective of this study is to describe the trend of opioid prescriptions for spine patients at 2 academic medical centers over the last 20 yr. METHODS A retrospective cohort study was conducted to identify patients with spine-related diagnoses at Brigham and Women's and Massachusetts General Hospitals between the years 1998 and 2018. The variables collected included demographics, diagnoses, and opioid medications. The analysis was conducted in R.v.3.0.1 software. ICD 9/10 were used to filter for spine-related diagnoses. A subanalysis was done based on the opioids route of administration (IV and oral). RESULTS Overall, there were a total of 26 507 patients with spine disease diagnoses, of which the median age was 64 (range 18–107), 77% were white, and 50% were male. The total number of opioid prescriptions between 1998 and 2018 was 1 045 691. Hydromorphone was the most prescribed with 922 018 prescriptions followed by oxycodone with 216 905. From 1998 to 2014, it was observed an increase of 36.8 times the number of opioid prescriptions. In 2015, there began a gradual reduction in the prescription rate to 4%, 10% in 2016, and 9% in 2017 compared to 2014. CONCLUSION The results of this study on spine patients well describe the magnitude of the opioid epidemic.The recent public health initiatives have started to reverse the crisis, but more efforts are needed to continue to reduce the severity of the crisis.

National Health Insurance and Health-Based Drug Policy: An Examination of Policy Linkages in the USA and Canada

2004 ◽  
Vol 33 (1) ◽  
pp. 133-151
Author(s):  
ELLEN BENOIT
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Drug Policy ◽  
Addiction Treatment ◽  
Universal Access ◽  
Public Health Problem ◽  
The United States ◽  
The Usa

For more than 50 years the United States and Canada maintained illegal-drug policies that followed the same course: a long period of punitive prohibition followed by moderation and an emphasis on drug abuse as a public health problem. Then in the 1980s, the USA reverted to a punitive model while Canada increased its commitment to a health-based approach. Why this divergence after following the same path for so long? In this paper I argue that one factor was Canada's adoption of national health insurance, which guaranteed universal access to health care, including addiction treatment. As the country's most popular policy it was protected against budget cuts during a period of welfare-state retrenchment in the 1980s. In the USA, on the other hand, public health insurance was limited to the elderly and the poor, and addiction treatment services were isolated and stigmatized. Thus the public health side of drug policy was poorly positioned to resist welfare cutbacks and ascendant criminal-justice interests. The experiences of the USA and Canada have implications for policy reformers and for the study of how institutional interests cross policy domains.

Myelomeningocele: surgical trends and predictors of outcome in the United States, 1988–2010

2014 ◽  
Vol 13 (6) ◽  
pp. 666-678 ◽  
Author(s):  
Varun R. Kshettry ◽  
Michael L. Kelly ◽  
Benjamin P. Rosenbaum ◽  
Andreea Seicean ◽  
Lee Hwang ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Hospital Stay ◽  
Low Income ◽  
Surgical Repair ◽  
The United States ◽  
Shunt Placement ◽  
Health Initiatives ◽  
Myelomeningocele Repair ◽  
Public Health Initiatives

Object Myelomeningocele repair is an uncommonly performed surgical procedure. The volume of operations has been decreasing in the past 2 decades, probably as the result of public health initiatives for folate supplementation. Because of the rarity of myelomeningocele, data on patient or hospital factors that may be associated with outcome are scarce. To determine these factors, the authors investigated the trends in myelomeningocele surgical repair in the United States over a 23-year period and examined patient and hospital characteristics that were associated with outcome. Methods The Nationwide Inpatient Sample database for 1988–2010 was queried for hospital admissions for myelomeningocele repair. This database reports patient, hospital, and admission characteristics and surgical trends. The authors used univariate and multivariate logistic regression to assess associations between patient and hospital characteristics and in-hospital deaths, nonroutine discharge, long hospital stay, and shunt placement. Results There were 4034 hospitalizations for surgical repair of myelomeningocele. The annual volume decreased since 1988 but plateaued in the last 4 years of the study. The percentages of myelomeningocele patients with low income (30.8%) and Medicaid insurance (48.2%) were disproportionately lower than those for the overall live-born population (p < 0.0001). More operations per 10,000 live births were performed for Hispanic patients (3.2) than for white (2.0) or black (1.5) patients (p < 0.0001). Overall, 56.6% of patients required shunt placement during the same hospital stay as for surgical repair; 95.0% of patients were routinely discharged; and the in-hospital mortality rate was 1.4%. Nonwhite race was associated with increased in-hospital risk for death (OR 2.8, 95% CI 1.2–6.3) independent of socioeconomic or insurance status. Conclusions Overall, the annual surgical volume of myelomeningocele repairs decreased after public health initiatives were introduced but has more recently plateaued. The most disproportionately represented populations are Hispanic, low-income, and Medicaid patients. Among nonwhite patients, increased risk for in-hospital death may represent a disparity in care or a difference in disease severity.

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