scholarly journals Development of quality indicators for the continued and safe delivery of Opioid Agonist Treatment (OAT), throughout and beyond COVID-19, using a Delphi Consensus technique

2021 ◽  
Vol 4 ◽  
pp. 90
Author(s):  
Gráinne Cousins ◽  
Louise Durand ◽  
Fiona Boland ◽  
Norma Harnedy ◽  
Íde Delargy ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Opioid Dependence ◽  
Clinical Decision Making ◽  
National Level ◽  
Healthcare Delivery ◽  
Unintended Consequences ◽  
Delphi Consensus ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Wide Range

Opioid agonist treatment (OAT) is the most effective treatment for opioid dependence, although it relies heavily on regular face-to-face healthcare delivery. Following the emergence of COVID-19, policies were rapidly changed in Ireland to reduce the risk of contracting the virus for both clients and treatment providers. From March 2020, the Health Service Executive (HSE) National Social Inclusion Office introduced a series of national contingency guidelines, to ensure fast and uninterrupted access to OAT while balancing efforts to mitigate COVID-19 risks. The Programme for Government 2020 states they will retain many of the measures introduced during the COVID-19 pandemic to reduce waiting times in accessing treatment services and reduce overdose mortality. It is therefore essential to examine the impacts, benefits and unintended consequences of the special measures introduced during COVID-19 at a national level, thus informing which measures can and should be sustained throughout and beyond COVID-19 to support effective, safe and patient-centered care promoting the health and wellbeing of all people with opioid dependence. The aim of this project is to identify priorities for quality improvements which will inform clinical decision making throughout and beyond the pandemic. This will be achieved through a Delphi consensus study. Quality indicators will be identified by comparing the national contingency guidelines with the national 2016 Clinical Guidelines. The project steering group will review the proposed indicators, and the agreed quality indicators will be integrated into an on-line Delphi questionnaire. One hundred participants will be invited to form the Delphi consensus panel and will include a wide range of stakeholders, including people accessing OAT services, general practitioners, pharmacists and outreach workers. Evidence generated from this study will inform national policy decisions in relation to improving quality of care in OAT.

scholarly journals Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with patients receiving injectable opioid agonist treatment

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Heather Palis ◽  
Kirsten Marchand ◽  
Gerald “ Spike” Peachey ◽  
Jordan Westfall ◽  
Kurt Lock ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Research Question ◽  
Substitution Effect ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Stimulant Use ◽  
Practice Elements ◽  
Concurrent Use ◽  
Wide Range

Abstract Background A high proportion of people receiving both oral and injectable opioid agonist treatment report concurrent use of stimulants (i.e. cocaine and or amphetamines), which has been associated with higher rates of continued illicit opioid use and treatment dropout. A recent randomized controlled trial demonstrated the effectiveness of dextroamphetamine (a prescribed stimulant) at reducing craving for and use of cocaine among patients receiving injectable opioid agonist treatment. Following this evidence, dextroamphetamine has been prescribed to patients with stimulant use disorder at a clinic in Vancouver. This study investigates perceptions of the effectiveness of dextroamphetamine from the perspective of these patients. Methods Data were collected using small focus groups and one-on-one interviews with patients who were currently or formerly receiving dextroamphetamine (n = 20). Thematic analysis was conducted using an iterative approach, moving between data collection and analysis to search for patterns in the data across transcripts. This process led to the defining and naming of three central themes responding to the research question. Results Participants reported a range of stimulant use types, including cocaine (n = 8), methamphetamine (n = 8), or both (n = 4). Three central themes were identified as relating to participants’ perceptions of the effectiveness of the medication: 1) achieving a substitution effect (i.e. extent to which dextroamphetamine provided a substitution for the effect they received from use of illicit stimulants); 2) Reaching a preferred dose (i.e. speed of titration and effect of the dose received); and 3) Ease of medication access (i.e. preference for take home doses (i.e. carries) vs. medication integrated into care at the clinic). Conclusion In the context of continued investigation of pharmacological treatments for stimulant use disorder, the present study has highlighted how the study of clinical outcomes could be extended to account for factors that contribute to perceptions of effectiveness from the perspective of patients. In practice, elements of treatment delivery (e.g. dosing and dispensation protocols) can be adjusted to allow for various scenarios (e.g. on site vs. take home dosing) by which dextroamphetamine and other pharmacological stimulants could be implemented to provide “effective” treatment for people with a wide range of treatment goals and needs.

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with injectable opioid agonist treatment patients

2021 ◽  
Author(s):  
Heather Palis ◽  
Kirsten Marchand ◽  
Gerald Spike Peachey ◽  
Jordan Westfall ◽  
Kurt Lock ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Research Question ◽  
Substitution Effect ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Stimulant Use ◽  
Practice Elements ◽  
Concurrent Use ◽  
Wide Range

Abstract Background: A high proportion of people receiving both oral and injectable opioid agonist treatment report concurrent use of stimulants (i.e. cocaine and or amphetamines), which has been associated with higher rates of continued illicit opioid use and treatment dropout. A recent randomized controlled trial demonstrated the effectiveness of dextroamphetamine (a prescribed stimulant) at reducing craving for and use of cocaine among patients receiving injectable opioid agonist treatment. Following this evidence, dextroamphetamine has been prescribed to patients with stimulant use disorder at a clinic in Vancouver. This study investigates perceptions of the effectiveness of dextroamphetamine from the perspective of these patients.Methods: Data were collected using small focus groups and one-on-one interviews with patients who were currently or formerly receiving dextroamphetamine (n=20). Thematic analysis was conducted using an iterative approach, moving between data collection and analysis to search for patterns in the data across transcripts. This process led to the defining and naming of three central themes responding to the research question. Results: Participants reported a range of stimulant use types, including cocaine (n=8), methamphetamine (n=8), or both (n=4). Three central themes were identified as relating to participants’ perceptions of the effectiveness of the medication: 1) achieving a substitution effect (i.e. extent to which dextroamphetamine provided a substitution for the effect they received from use of illicit stimulants); 2) Reaching a preferred dose (i.e. speed of titration and effect of the dose received); and 3) Ease of medication access (i.e. preference for take home doses (i.e. carries) vs. medication integrated into care at the clinic).Conclusion: In the context of continued investigation of pharmacological treatments for stimulant use disorder, the present study has highlighted how the study of clinical outcomes could be extended to account for factors that contribute to perceptions of effectiveness from the perspective of patients. In practice, elements of treatment delivery (e.g. dosing and dispensation protocols) can be adjusted to allow for various scenarios (e.g. on site vs. take home dosing) by which dextroamphetamine and other pharmacological stimulants could be implemented to provide “effective” treatment for people with a wide range of treatment goals and needs.

Gaps Between Alarm Capabilities and Decision-making Needs: An Observational Study of Detecting Patient Decompensation

2018 ◽  
Vol 7 (1) ◽  
pp. 112-116 ◽  
Author(s):  
Chelsea R. Horwood ◽  
Michael F. Rayo ◽  
Morgan Fitzgerald ◽  
E. Asher Balkin ◽  
Susan D. Moffatt-Bruce
Keyword(s):  
Decision Making ◽  
Early Warning ◽  
Clinical Decision Making ◽  
Vital Signs ◽  
Clinical Decision ◽  
Unintended Consequences ◽  
Warning Signs ◽  
Medical Setting ◽  
Mental Picture ◽  
Wide Range

Decompensation is a change in the overall ability to maintain physiological function in the presence of a stressor or disease. In the medical setting, clinicians utilize a wide range of technological tools to aid in their clinical decision making and to identify early warning signals for decompensation. However, many of these technologies have underperformed and are not aligned with the actual role of practitioners, resulting in unintended consequences and adverse events. The primary aim of this study is to explore how different nurses interpret early warning signs in order to anticipate decompensation. The secondary aim is to assess which technologies nurses rely on when anticipating decompensation, and if those technologies are adequately aiding them in their clinical decision making. Two researchers performed semi-structured ethnographic interviews that were recorded and transcribed during the summer of 2017. In total, 43 nurses were interviewed from different medical and surgical floors within the same hospital. Participants were asked questions focused on how they use and respond to alarms and how they anticipate patient decompensation. Constant Comparative Analysis was used to reveal patterns of responses between participants. Based on the qualitative analysis 6 major themes emerged:  1. Anticipating patient decompensation requires creating a complete mental “picture of the patient” by the nurses  2. Nurse-to-nurse communication and expertise is essential to understanding the patient’s history  3. Warning signs for decompensation were largely determined by a patient’s baseline  4. Change over time, or trends, is informative for anticipating decompensation. Numbers (regarding vital signs and labs) alone are not  5. Consistent care of patients improved nurse’s confidence in decision making  6. Anticipating decompensation requires “staying ahead of the machines Our research suggests that there is a gap between the information practitioners need to accurately anticipate patient decompensation, and the information current alarm technologies provide. Alarms are the primary tool provided to nurses to aid them in detecting hazardous events, however, current alarms are not well-suited in supporting signals that anticipate patient decompensation before it happens.

scholarly journals Prevalence of Opioid Dependence and Opioid Agonist Treatment in the Berlin Custodial Setting: A Cross-Sectional Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Kira von Bernuth ◽  
Peter Seidel ◽  
Julia Krebs ◽  
Marc Lehmann ◽  
Britta Neumann ◽  
...  
Keyword(s):  
Opioid Dependence ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Opioid Agonist ◽  
Cross Sectional ◽  
Opioid Agonist Treatment

scholarly journals Effectiveness and Safety of Low-Threshold Opioid-Agonist Treatment in Hard-To-Reach Populations with Opioid Dependence

2021 ◽  
pp. 1-11
Author(s):  
Fatemeh Chalabianloo ◽  
Christian Ohldieck ◽  
Øystein A. Haaland ◽  
Lars Thore Fadnes ◽  
Kjell Arne Johansson
Keyword(s):  
Healthcare Utilization ◽  
Opioid Dependence ◽  
Treatment Retention ◽  
Retention Rates ◽  
Vulnerable Groups ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Fatal Overdose ◽  
Low Threshold

<b><i>Objectives:</i></b> Opioid-use disorder is related to premature death worldwide. Opioid-agonist treatment (OAT) is an effective treatment for opioid dependence. OAT delivery platforms may influence treatment access and outcomes, especially for the most vulnerable groups. The aim of this study was to determine the effectiveness and safety of low-threshold OAT compared to the standard treatment. <b><i>Methods:</i></b> Patients with diagnosed opioid dependence undergoing low-threshold OAT at the Bergen delivery platform in Norway were enrolled in a cohort study in 2014–2019. A national OAT cohort was the reference group. The main outcomes were treatment retention, the use of illicit opioids, non-fatal overdose, overdose death, and all-cause mortality during the first year following treatment initiation and the full treatment period. Additionally, healthcare utilization in the periods before and during OAT was investigated. <b><i>Results:</i></b> Compared to the reference cohort, the low-threshold cohort (<i>n</i> = 128, mean age: 38 years, women: 28%) showed treatment retention rates of 95% versus 92%, illicit opioid use of 7% versus 10%, non-fatal overdose of 7% versus 6%, and death at 1.0% versus 1.3%, respectively. The incident rate ratios (IRRs) for healthcare utilization increased substantially during the OAT period compared to the period before; the IRR increased by 3.3 (95% confidence interval (CI): 2.8, 3.9) and 3.4 (95% CI: 3.1, 3.9) for all in- and outpatient healthcare, respectively. <b><i>Conclusions:</i></b> Low-threshold OAT was at least as effective and safe as the standard OAT in terms of treatment retention, the use of illicit opioids, non-fatal overdose, and death. Healthcare utilization increased during the OAT compared to the period before. Lowering the threshold for OAT entrance within proper delivery platforms should be broadly considered to reduce harm and improve healthcare access among patients with opioid dependence.

scholarly journals Impact of the COVID-19 pandemic on opioid agonist treatment in Ireland: Protocol for an interrupted time series analysis

2021 ◽  
Vol 4 ◽  
pp. 91
Author(s):  
Gráinne Cousins ◽  
Louise Durand ◽  
Fiona Boland ◽  
Norma Harnedy ◽  
Íde Delargy ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Healthcare Delivery ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Series Analysis ◽  
Number Of Patients ◽  
The Impact

While opioid agonist treatment (OAT) is the most effective treatment for opioid dependence, it is heavily dependent on regular face-to-face healthcare delivery placing both clients and treatment providers at risk of COVID-19. Following the emergence of COVID-19, policies were rapidly changed in Ireland, with the introduction of national contingency guidelines by the HSE National Social Inclusion Office, beginning in March 2020 to ensure rapid and uninterrupted access to OAT while balancing efforts to mitigate COVID-19 risk. This study aims to assess the impact of the national contingency guidelines, on the quality of OAT care delivered in Ireland. An interrupted time series analysis will be conducted using anonymised aggregated level data obtained from the Central Treatment List (CTL), the national register of people receiving OAT, administered by the National Drug Treatment Centre Board on behalf of the HSE. Separate segmented regressions will be conducted to estimate the impact of the national contingency guidelines on the following outcomes: (1) number of patients in treatment; (2) number of patients starting OAT; (3) average waiting time for treatment; (4) number of people on waiting list; (5) number of patients dropping out of treatment.  The study period will be divided into pre-(March 2019 to February 2020) and post- intervention (April 2020 to March 2021) segments. Immediate (change in level) and longer-term impacts (change in slope) of changes to provision of OAT in each of the outcomes will be investigated. Regression coefficients (β) and 95% confidence intervals (CIs) will be reported.

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