Outcomes from the medication assisted treatment pilot program for adults with opioid use disorders in rural Colorado

Abstract Background As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence- based treatment to 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1005 patients receiving MOUD from the 3 participating organizations. Here we evaluate patient centered clinical and functional outcomes of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis. Methods Under state-funded law (Colorado Senate Bill 17–074), three rural agencies submitted de-identified patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index, PhQ9 and GAD-7 with McNemar-Bowker, and Wilcoxon Signed Rank tests analysis were used to measure patient outcomes across after participation in the program. . Results Patients in treatment reported using less heroin (52.1% vs 20.4%), opioids (22.3% vs 11.0%), and alcohol (28.6% vs 13.1%, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less frequency of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5% to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment. Conclusions This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado’ major public health crises.

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Outcomes from the Medication Assisted Treatment Pilot Program for Adults With Opioid Use Disorders in Rural Colorado

10.21203/rs.3.rs-769124/v1 ◽

2021 ◽

Author(s):

Claudia R. Amura ◽

Tanya R. Sorrell ◽

Mary Weber ◽

Andrea Alvarez ◽

Nancy Beste ◽

...

Keyword(s):

Health Care Providers ◽

Rural Areas ◽

Addiction Severity Index ◽

Lessons Learned ◽

Opioid Overdose ◽

Pilot Program ◽

Care Providers ◽

Physical And Mental Health ◽

Opioid Use ◽

The Impact

Abstract Background. As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence based treatment 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1,005 patients receiving MOUD from the 3 participating organizations. Here we evaluate the impact of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis on patient centered clinical and functional outcomes. Methods. Under state-funded law, three rural agencies submitted patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index with McNemar-Bowker and t tests were used to measure program impact. Results. Patients in treatment reported using less heroin (13.0 vs. 3.7 days), opioids (3.7 vs. 1.9 days), and alcohol (3.2 vs 0.7 days, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less days of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5 % to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment. Conclusions. This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado’ major public health crises.

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Experiences of health care providers on pregnancy and childbirth care during the COVID-19 pandemic in Iran: a phenomenological study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04148-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sedigheh Hantoushzadeh ◽

Maryam Bagheri ◽

Marjan Akhavan Amjadi ◽

Maryam Farmahini Farahani ◽

Fedyeh Haghollahi

Keyword(s):

Health Care ◽

Health Care Providers ◽

Maternity Care ◽

Phenomenological Study ◽

Lessons Learned ◽

Care Providers ◽

Physical And Mental Health ◽

Structured Interviews ◽

Pregnancy And Childbirth ◽

Childbirth Care

Abstract Background Coronavirus currently cause a lot of pressure on the health system. Accordingly, many changes occurred in the way of providing health care, including pregnancy and childbirth care. To our knowledge, no studies on experiences of maternity care Providers during the COVID-19 Pandemic have been published in Iran. We aimed to discover their experiences on pregnancy and childbirth care during the current COVID-19 pandemic. Methods This study was a qualitative research performed with a descriptive phenomenological approach. The used sampling method was purposive sampling by taking the maximum variation possible into account, which continued until data saturation. Accordingly, in-depth and semi-structured interviews were conducted by including 12 participants, as 4 gynecologists, 6 midwives working in the hospitals and private offices, and 2 midwives working in the health centers. Data were analyzed using Colaizzi’s seven stage method with MAXQDA10 software. Results Data analysis led to the extraction of 3 themes, 9 categories, and 25 subcategories. The themes were as follows: “Fear of Disease”, “Burnout”, and “Lessons Learned from the COVID-19 Pandemic”, respectively. Conclusions Maternal health care providers experience emotional and psychological stress and work challenges during the current COVID-19 pandemic. Therefore, comprehensive support should be provided for the protection of their physical and mental health statuses. By working as a team, utilizing the capacity of telemedicine to care and follow up mothers, and providing maternity care at home, some emerged challenges to maternal care services can be overcome.

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Implementation of Clinical Algorithms for Take-Home Naloxone and Buprenorphine/ Naloxone in Emergency Rooms: SuboxED Project Evaluation

Medical & Clinical Research ◽

10.33140/mcr.05.10.03 ◽

2020 ◽

Vol 5 (10) ◽

Keyword(s):

At Risk ◽

Health Care Providers ◽

Point Of Care ◽

Free Access ◽

Opioid Overdose ◽

Care Providers ◽

Opioid Use ◽

Opioid Agonist ◽

Eligibility Criteria ◽

Clinical Algorithm

Introduction: Emergency departments (EDs) are often the first point of care for people at risk of opioid-related overdose, an issue on the rise in Canada. Dispensing take-home naloxone (THN) and/or initiating opioid agonist treatment (OAT) in the ED can help prevent overdose. Methods: The SuboxED (CC-BY-NC-SA) project evaluated the implementation of a clinical algorithm for dispensing THN and prescribing buprenorphine/naloxone (B/n) in three EDs in the province of Québec. We performed a retrospective review of ED electronic medical records flagged as “at risk of opioid overdose (ROO).” This study included an implementation process from April 1, 2018 to April 30, 2019, and an evaluation of the project implementation for eligible patients from May 1 to December 31, 2019. We also administered satisfaction surveys to medical teams and patients. Results: A total of 877 (36.2%) patient records were included in the analysis. Of these, 62% had a confirmed diagnostic of opioid use disorder (OUD) and 70.8% met eligibility criteria for naloxone prescription. However, only 7.7 % were given a prescription or take-home naloxone in the ED, and 12.4 % were initiated on B/n in the ED or in the community after the ED visit. Seven patients and 125 health care providers from EDs, clinics, and retail pharmacies completed the survey. Conclusion: The SuboxED project demonstrated the feasibility of implementing a clinical algorithm for dispensing THN and initiating B/n in the ED, and of evaluating its efficacy in the 6 months following implantation. In addition to advocating for free access to THN in EDs, scaling up the uptake of the algorithm in EDs is the next challenge.

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Our Ethical Obligation to Treat Opioid Use Disorder in Prisons: A Patient and Physician's Perspective

The Journal of Law Medicine & Ethics ◽

10.1177/1073110518782933 ◽

2018 ◽

Vol 46 (2) ◽

pp. 268-271 ◽

Cited By ~ 6

Author(s):

Curtis Bone ◽

Lindsay Eysenbach ◽

Kristen Bell ◽

Declan T. Barry

Keyword(s):

Health Care Providers ◽

The United States ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Care Providers ◽

Opioid Use ◽

Ethical Obligation ◽

Medication Assisted Treatment ◽

Improved Outcomes ◽

Poor Outcomes

The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT (i.e. methadone, buprenorphine) is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration.

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

Qualitative Research in Medicine & Healthcare ◽

10.4081/qrmh.2020.9175 ◽

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.

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Updates in the Prevalence of Rotavirus Gastroenteritis in Babylon City

Al Mustansiriyah Journal of Pharmaceutical Sciences ◽

10.32947/ajps.18.2.369 ◽

2018 ◽

pp. 1-12

Keyword(s):

Health Care Providers ◽

Rural Areas ◽

Causative Organism ◽

Care Providers ◽

Sample Collection ◽

Rotavirus Infection ◽

Rotavirus Gastroenteritis ◽

Age Range ◽

Latex Test ◽

Children Under 5

Background: Diarrhea is a main cause of morbidity and mortality in children under 5 years old. Globally it is responsible for approximately four billion cases and three million deaths annually. In developing countries, it causes two million deaths each year. The major causative organism is rotavirus which is responsible for one-third of hospitalizations with approximately 40% mortality. Objectives: To determine the prevalence and demographic characteristics of rotavirus infection in Babylon city, Iraq. Materials and Methods: Fecal samples were taken from children with age range of 6 months to 5 years complained of diarrhea during the period beginning in October 2016 till August 2017. The age, gender, residence, the type of feeding, place of the sample collection and duration of diarrhea were recorded. Specimens were analyzed by Latex test for detection of rotavirus. Results: A total of 349 children presented with diarrhea, the rotavirus antigen was detected in 169 fecal specimens from children with diarrhea (48%). More percentages of positive rotavirus specimens were seen in the 5year of age. No gender differences were observed, meanwhile samples obtained from rural areas and breastfed children showed less rotavirus positive infection. Conclusion: The present study confirms that rotavirus infection is still currently a prevalent gastroenteritis causative agent and required careful clinical attention. Pediatricians and health care providers are needed to be encouraged to take into account the children who at risk for developing rotavirus infection including age, residence and type of feeding.

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Updates in the Prevalence of Rotavirus Gastroenteritis in Babylon City

Al Mustansiriyah Journal of Pharmaceutical Sciences ◽

10.32947/ajps.18.02.369 ◽

2018 ◽

pp. 1-12

Keyword(s):

Health Care Providers ◽

Rural Areas ◽

Causative Organism ◽

Care Providers ◽

Sample Collection ◽

Rotavirus Infection ◽

Rotavirus Gastroenteritis ◽

Age Range ◽

Latex Test ◽

Children Under 5

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Barriers and Facilitators of Using Telehealth to Identify and Manage Behavioral Health and Substance Use Disorder Conditions in Rural Areas: An Environmental Scan (Preprint)

10.2196/preprints.22025 ◽

2020 ◽

Author(s):

Naim Naim ◽

Laura Dunlap

Keyword(s):

Substance Use ◽

Behavioral Health ◽

Substance Use Disorder ◽

Rural Areas ◽

Primary Care Providers ◽

Care Patient ◽

Direct Patient Care ◽

Care Providers ◽

Provider Education ◽

Opioid Use

BACKGROUND Access to behavioral health services, particularly substance use disorder (SUD) treatment services, is challenging in rural and other underserved areas. Some of the reasons for these challenges include local primary care providers without experience in behavioral health treatment, few specialty providers, and concerns over stigma and lack of privacy for individuals from smaller communities. Telehealth can ease these challenges and support behavioral health, specifically SUD treatment, in a variety of ways, including direct patient care, patient engagement, and provider education. Telehealth is particularly relevant for the growing opioid epidemic, which has profoundly affected rural areas. OBJECTIVE We sought to understand how telehealth is used to support behavioral health and SUDs, with a particular focus on implications for medication-assisted treatment for opioid use disorders. The intent was to understand telehealth implementation and use, financing and sustainability, and impact in the field. The results of this work can be used to inform future policy and practice. METHODS We reviewed literature and interviewed telehealth stakeholders and end users in the field. The team identified a diverse set of participants, including clinical staff, administrators, telehealth coordinators, and information technology staff. We analyzed research notes to extract themes from participant experiences to answer the study questions. RESULTS Organizations varied in how they implemented telehealth services and the services they offered. Common themes arose in implementation, such as planning for technical and organizational impacts of telehealth, the importance of leadership support, and tailoring programs to community needs. CONCLUSIONS Telehealth is used in a variety of ways to expand access to services and extend service delivery. As the policy and reimbursement landscape continues to evolve, there may be corresponding changes in telehealth uptake and services provided. CLINICALTRIAL NA

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Medical Informatics and the Quality of Health: New Approaches to Support Patient Care

Methods of Information in Medicine ◽

10.1055/s-0038-1634331 ◽

2003 ◽

Vol 42 (02) ◽

pp. 185-189 ◽

Cited By ~ 10

Author(s):

R. Haux ◽

C. Kulikowski ◽

A. Bohne ◽

R. Brandner ◽

B. Brigl ◽

...

Keyword(s):

Health Care ◽

Medical Informatics ◽

Health Care Providers ◽

Medical Knowledge ◽

Lessons Learned ◽

Care Providers ◽

Access To Health Services ◽

Leading Role ◽

Future Challenges

Summary Objectives: The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of excellent papers on medical informatics research which have been recently published (www.yearbook.uni-hd.de). The 2003 Yearbook of Medical Informatics took as its theme the role of medical informatics for the quality of health care. In this paper, we will discuss challenges for health care, and the lessons learned from editing IMIA Yearbook 2003. Results and Conclusions: Modern information processing methodology and information and communication technology have strongly influenced our societies and health care. As a consequence of this, medical informatics as a discipline has taken a leading role in the further development of health care. This involves developing information systems that enhance opportunities for global access to health services and medical knowledge. Informatics methodology and technology will facilitate high quality of care in aging societies, and will decrease the possibilities of health care errors. It will also enable the dissemination of the latest medical and health information on the web to consumers and health care providers alike. The selected papers of the IMIA Yearbook 2003 present clear examples and future challenges, and they highlight how various sub-disciplines of medical informatics can contribute to this.

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Older Adults and Opioid Education: Lessons Learned From Experiences in Rural Arkansas

Innovation in Aging ◽

10.1093/geroni/igaa057.177 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 54-54

Author(s):

Robin McAtee ◽

Leah Tobey ◽

Corey Hayes ◽

Laura Spradley ◽

Sajni Kumpuris

Keyword(s):

Older Adults ◽

Pain Management ◽

Rural Areas ◽

Term Treatment ◽

Lessons Learned ◽

Opioid Use ◽

Farm Bureau ◽

Department Of Health ◽

Long Term Treatment ◽

Agricultural Areas

Abstract Nearly one-third of all Medicare participants were prescribed an opioid by their physician in 2015 (AARP, 2017) and in 2017, Arkansas had the 2nd highest opioid prescribing rate in the nation (CDC, 2019). Approaching older adults (OA) about opioids and pain management can be a sensitive topic. Educating and altering long-term treatment with opioids is especially challenging in rural areas where literacy, especially health literacy, is suboptimal. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve health outcomes including an emphasis to decrease the misuse and abuse of opioids among older Arkansans. To address this crisis, the AGEC partnered with local leaders such as the AR Drug Director, academia, Department of Health and Human Services, and multiple community based organizations to create age-tailored educational programs. Unique aspects of approaching and educating rural OA about opioids and pain management will be reviewed. Outcomes will be discussed such as their lack of knowledge about: what is an opioid, why they were prescribed, and what are viable alternatives. Also discussed will be lessons learned that resulted in more effective methods of reaching and teaching rural OA. Partnering with the AR Farm Bureau helped the AGEC reach 100’s of farmers in the extremely rural and mostly agricultural areas. Learning to not use the word opioid resulted in more participants and in a more positive attitude and outlook on attempts to change the culture of opioid use, misuse and abuse among older Arkansans.

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