Treatment Persistence Among Insured Patients Newly Starting Buprenorphine/Naloxone for Opioid Use Disorder

2018 ◽  
Vol 52 (5) ◽  
pp. 405-414 ◽  
Author(s):  
Natalia Shcherbakova ◽  
Gary Tereso ◽  
Jacqueline Spain ◽  
Robert J. Roose
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Care Providers ◽  
Opioid Use ◽  
Treatment Persistence ◽  
Factors Associated ◽  
Insured Patients

Background: Persistence with medication-assisted therapy among patients with opioid use disorder has been associated with reduced likelihood of illicit opioid use. Objective: We aimed to describe treatment persistence and identify factors associated with 1-year persistence among insured patients newly initiating buprenorphine-containing pharmacotherapy. Methods: The retrospective observational cohort included employer-sponsored and managed Medicaid patients newly started on buprenorphine-containing therapy between June 30, 2010, and January 1, 2015. Persistence was measured as both a continuous and dichotomous variable (proportion of patients persistent for 1 year). Multivariable logistic regression analysis was used to identify factors associated with 1-year persistence. Results: A total of 302 patients met inclusion criteria. The median [range] number of treatment episodes was 1 [1-4]. Mean number of days on therapy during the first episode was 206 (SD = 152) days, with 40.4% (n = 122) of patients persisting for 1 year. Presence of concomitant fills of prescription opioid analgesics (odds ratio [OR] = 0.25; 95% CI = 0.12-0.51), being in care of an addiction specialist (OR = 0.40; 95% CI = 0.21-0.76), and Medicaid insurance coverage (OR = 0.33; 95% CI = 0.13-0.84) were significantly and negatively associated with 1-year persistence. There was also a strong inverse relationship between persistence and inpatient hospitalization (OR = 0.30; 95% CI = 0.12-0.76). Conclusions: Several health care delivery and use variables were significantly associated with nonpersistence. Concomitant use of prescription opioids is the most easily modifiable risk factor that health care providers and policy makers may act on to improve treatment continuation.

scholarly journals An ethnographic study of opioid use disorder in rural Maine: The problem of pain

2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Weronika Grabowska ◽  
Selma Holden ◽  
Peter M Wayne ◽  
Karen Kilgore
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Opioid Use Disorder ◽  
Ethnographic Study ◽  
Community Leaders ◽  
Medical Setting ◽  
Opioid Overdose ◽  
Care Providers ◽  
Opioid Use ◽  
Structured Interviews

This qualitative study was conducted to more fully understand health care providers and community leaders’ perceptions of the opioid crisis in rural Maine. In 2017, Maine continued to have one of the highest opioid overdose death rates in the country, more than double the national average. I (first author) visited eight treatment centers in Maine providing support and treatment to people recovering form Opioid Use Disorder (OUD), shadowing health care providers. I also attended OUD-related meetings held with community leaders. I conducted a total of 33 semi-structured interviews with health care providers, community leaders, and NGOs in the state of Maine. Three themes emerged integrating observations with semi-structured interviews: i) Impact of emergence of new extended release opioids, their prescription patterns, and culture around them; ii) Subjectivity of pain and importance of understanding psychic injury in OUD treatment; iii) Socio-political context and perception of OUD in Maine. Our society’s perception of pain has deep historical and cultural sources that influence the way that pain has been perceived and treated in the medical setting. Resources beyond the medical environment are needed to address pain adequately.

scholarly journals Opioid Use Disorder: Screening, Diagnosis, and Management

2021 ◽  
Vol 16 (2) ◽  
pp. 25-30
Author(s):  
Privia Randhawa ◽  
Seonaid Nolan
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
The Past ◽  
Opioid Crisis ◽  
Safe Opioid Prescribing

Over the past decade, the opioid crisis in Canada has been worsening. In 2019, over 3,800 people across Canada died due to an apparent opioid-related cause, which represents a 26% increase from just 3 years prior. Given North America’s ongoing opioid crisis, and the contribution opioid-prescribing practices have had to date, a critical need exists to ensure that health care providers are not only educated about safe opioid prescribing but also are knowledgeable about how to effectively screen for, diagnose, and treat an individual with opioid use disorder. RésuméAu cours des dix dernières années, la crise des opioïdes au Canada n’a cessé de s’aggraver. En 2019, plus de 3 800 personnes au Canada sont décédées d’une cause apparemment liée à la consommation d’opioïdes, ce qui représente une augmentation de 26 % par rapport à seulement trois ans auparavant. Étant donné la crise des opioïdes qui sévit actuellement en Amérique du Nord et la contribution des pratiques de prescription d’opioïdes qui ont eu cours jusqu’ici, un besoin critique est à combler pour veiller à ce que les fournisseurs de soins soient non seulement formés sur la prescription sécuritaire des opioïdes, mais aussi bien informés sur le dépistage, le diagnostic et le traitement efficace d’un trouble lié à la consommation d’opioïdes.

Genetic Predispositions, Prophylactic Treatments and Private Health Insurance: Nothing is Better Than a Good Pair of Genes

1997 ◽  
Vol 23 (1) ◽  
pp. 45-68 ◽  
Author(s):  
Alexandra K. Glazier
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Genetic Predisposition ◽  
Genetic Linkage ◽  
Dna Analysis ◽  
Care Delivery ◽  
Medical Community ◽  
Care Providers ◽  
Linkage Studies ◽  
Prophylactic Measures

Discovering the genetic basis of a particular disease is not only of great interest to the medical community; private health insurers are also anxiously awaiting the results of genetic linkage studies. Apart from the scientific value of DNA studies, the results of genetic linkage research are relevant to health care delivery in two principal ways. First, identifying the genetic origin of a disease may allow doctors to detect the disease earlier. If doctors know that an individual is genetically predisposed to a particular disease, then health care providers can increase screening efforts and watch for early symptoms. Second, if an individual has a genetic predisposition to a particular disease, health care providers may employ preventive or “prophylactic" measures to reduce or eliminate the risk of developing the disease or condition to which the individual is genetically predisposed. Genetic linkage studies will soon allow more individuals to learn of their own genetic predispositions to certain diseases. Currently genetic predisposition tests (both pedigrees of family history and DNA analysis) can indicate that an individual is at high risk for developing a disease.

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

Challenges of Providing Health Care in Complex Emergencies: A Systematic Review

2021 ◽  
pp. 1-5
Author(s):  
Hesam Seyedin ◽  
Morteza Rostamian ◽  
Fahimeh Barghi Shirazi ◽  
Haleh Adibi Larijani
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Services ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Qualitative Content Analysis ◽  
Care Delivery ◽  
Information Access ◽  
Care Providers ◽  
Complex Emergencies

Abstract Providing health care in times of complex emergencies (CEs) is one of the most vital needs of people. CEs are situations in which a large part of the population is affected by social unrest, wars, and food shortages. This systematic review study was conducted to identify the challenges of health-care delivery in CEs. We searched terms related to health-care delivery and CEs in PubMed, Web of Sciences, Science Direct, and Google scholar databases, as well as Persian databases SID and Magiran. The searching keywords included: “Health Care, Complex Crises, War, Humanitarian, Refugees, Displaced Persons, Health Services, and Challenges.” Of 409 records, we selected 6 articles based on the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist. Studies were analyzed through qualitative content analysis. The results show that CEs affect health-care delivery in 4 primary areas: the workforce, infrastructure, information access, and organization of health services. These areas can pose potential threats for health-care providers and planners at times of emergencies. Thus, they should be informed about these challenges to strengthen the health-care system.

scholarly journals Continuity of care in Ghana: the promise of smart-med

2014 ◽  
Vol 3 (4) ◽  
pp. 473
Author(s):  
Henry Ogoe ◽  
Odame Agyapong ◽  
Fredrick Troas Lutterodt
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Continuity Of Care ◽  
Medical Information ◽  
Care Delivery ◽  
Personal Health Records ◽  
Personal Health ◽  
Care Providers ◽  
Health Records ◽  
Fragmentation Of Care

Individuals tend to receive medical care from different health care providers as they drift from one location to another. Oftentimes, multiple providers operate disparate systems of managing patients medical records. These disparate systems, which are unable to share and/or exchange information, have the propensity to create fragmentation of care, which poses a serious threat to the realization of continuity of care in the Ghanaian health care delivery. Continuity of care, which is the ability to seamlessly access, update, and manage patients medical information as they visit multiple providers, is a crucial component of quality of care in any health delivery system. The current system of managing patients records in Ghanapaper-basedmakes continuity of care difficult to actualize. To this end, we have developed a smartcard based personal health records system, SMART-MED, which can effectively promote continuity of care in Ghana. SMART-MED is platform-independent; it can run as standalone or configured to plug into any Java-based electronic medical record system. Results of a lab simulation test suggest that it can effectively promote continuity of care through improved data security, support interoperability for disparate systems, and seamless access and update of patients health records. Keywords: Continuity of Care, Fragmentation of Care, Interoperability, Personal Health Records, Smartcard.

scholarly journals Influencing Factors for Prevention of Postpartum Hemorrhage and Early Detection of Women at Risk in The Northern Province of Rwanda: Beneficiary and Health Worker Perspectives

2020 ◽  
Author(s):  
Oliva Bazirete ◽  
Manassé Nzayirambaho ◽  
Aline Umubyeyi ◽  
Marie Chantal Uwimana ◽  
Evans Marilyn
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Early Detection ◽  
Focus Groups ◽  
Health Care Providers ◽  
Health Workers ◽  
Northern Province ◽  
Care Providers ◽  
Factors Associated ◽  
Childbearing Women

Abstract Background: Reduction of maternal mortality and morbidity is a major global health priority. However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for prevention of PPH and early detection of women at risk as perceived by beneficiaries and health workers in the Northern Province of Rwanda. Methods: A qualitative descriptive exploratory study was drawn from a larger sequential exploratory‐mixed methods study. Semi‐structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women’s partners or close relatives (2 focus groups), community health workers (CHWs) in charge of maternal health (2 focus groups) and health care providers (3 focus groups). A socio ecological model was used to develop interview guides to describe factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. Results: We generated four interrelated themes: (1) Meaning of PPH: beliefs, knowledge and understanding of PPH: (2) Organizational factors; (3) Caring and family involvement and (4) Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH. Conclusions: Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. Involvement of all levels of the health system was recommended for a proactive prevention of PPH. Further quantitative research, using case control design is warranted to develop a screening tool for early detection of PPH risk factors for a proactive prevention.

scholarly journals Potential Benefits and Drawbacks of Virtual Clinics in General Surgery: Pilot Cross-Sectional Questionnaire Study (Preprint)

2018 ◽  
Author(s):  
Emily Rutherford ◽  
Roghinio Noray ◽  
Caolán Ó HEarráin ◽  
Kevin Quinlan ◽  
Aisling Hegarty ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health Care Providers ◽  
Care Delivery ◽  
Day Surgery ◽  
Care Providers ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Specialist Health Care ◽  
Outpatient Settings

BACKGROUND Escalating demand for specialist health care puts considerable demand on hospital services. Technology offers a means by which health care providers may increase the efficiency of health care delivery. OBJECTIVE The aim of this study was to conduct a pilot study of the feasibility, benefits, and drawbacks of a virtual clinic (VC) in the general surgical service of a busy tertiary center. METHODS Patient satisfaction with current care and attitudes to VC were surveyed prospectively in the general surgical outpatient department (OPD; n=223). A subset of patients who had undergone endoscopy and day surgery were recruited to follow-up in a VC and subsequently surveyed with regard to their satisfaction (20/243). Other outcomes measured included a comparison of consultation times in traditional and virtual outpatient settings and financial cost to both patients and the institution. RESULTS Almost half of the patients reported barriers to prospective use of VCs. However, within the cohort who had been followed-up in the VC, satisfaction was higher than the traditional OPD (100% as compared with 187/223, 83.9%). Significant savings in both time (<italic>P</italic>=.003) and financial costs to patients and the institution were found. CONCLUSIONS For an appropriately selected group of patients, VCs offer a viable alternative to traditional OPD. This alternative can improve both patient satisfaction and efficiency of patient care.

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