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

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-021-00424-4 ◽

2022 ◽

Vol 17 (1) ◽

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 ◽

Long Term Effects ◽

Opioid Use

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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Identifying and describing a model region to evaluate the impact of telemedicine

European Journal of Public Health ◽

10.1093/eurpub/ckz185.427 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

L Harst ◽

S Oswald ◽

P Timpel

Keyword(s):

Health Care ◽

Focus Group ◽

Focus Groups ◽

Health Care Providers ◽

Rural Areas ◽

Demographic Data ◽

Care Providers ◽

Age Related ◽

Model Region ◽

The Impact

Abstract Background Telemedicine solutions providing patient-centered care over distance need to be integrated into the regional setting. The acceptance by both providers and patients hat to be continuously evaluated using methods of participatory implementation research. In controlled trials, often taking place in laboratory settings, these methods cannot be applied. In the following, research in progress is presented. Methods Based on socio-demographic data, epidemiology prevalence of age-related chronic diseases and data on the value of health care provision in Saxony, Germany a model region was chosen. Then, a focus group (n = 6) was conducted to differentiate the results and analyze the health networks of patients. For this, network maps putting the individual in the middle and his/her sources of information and support in case of illness in concentric circles around it, were used. The focus group was audiotaped, transcribed and analyzed by two researchers using MaxQDA. Results With a mean age of 47.8 years (n = 17,431), high prevalence of diabetes (>15.85 %) and hypertension (>39.1%) and an expected shortage of primary physicians in 2030, the town of Kamenz is a mirror image of the current health care challenges in rural areas of Saxony. Participants of the focus groups also stated problems in finding a primary physician or a dentist. Compensatory behavior, such as traveling large distances, relying on self-researched online diagnoses and immediately going to the emergency room for medical support was described. According to the network maps, primary sources of support in case of illness are partners and relatives, yet there is little connection between those and health care providers, as well as between different medical specialists. Conclusions The results will lead to potential use cases of telemedicine to be included into a standardized questionnaire for the assessment of telemedicine readiness in the model region. Key messages Telemedicine implementation in a rural area can be studied using a participatory approach. Focus groups and network maps are useful qualitative methods for participatory research and can inform the design of quantitative measurements.

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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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The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

10.2337/figshare.13103333.v1 ◽

2020 ◽

Author(s):

Andrea M. Kriska ◽

Bonny Rockette-Wagner ◽

Sharon L. Edelstein ◽

George A. Bray ◽

Linda M. Delahanty ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Prevention ◽

Cox Proportional Hazards ◽

Lessons Learned ◽

Diabetes Incidence ◽

Care Providers ◽

Cross Sectional ◽

Entire Cohort ◽

The Impact

Objective: Across the DPP follow-up, cumulative diabetes incidence remained lower in the lifestyle compared to placebo and metformin randomized groups and could not be explained by weight. Collection of self-reported PA (yearly) with cross-sectional objective PA (in follow-up) allowed for examination of PA and its long-term impact on diabetes prevention. Research Design and Methods: Yearly self-reported PA and diabetes assessment, OGTT, (fasting glucose semi-annually) was collected for 3232 participants with one accelerometry assessment 11-13 years after randomization (n=1,793). Mixed models determined PA differences across treatment groups. The association between PA and diabetes incidence was examined using Cox proportional hazards models. Results: There was a 6% decrease (Cox proportional HR 0.94 [0.92, 0.96]; P< 0.001) in diabetes incidence per 6 MET-hrs/week increase in time-dependent PA for the entire cohort over an average 12 years (controlled for age, sex, baseline PA and weight). The effect of PA was greater (12% decrease) among participants less active at baseline (<7.5 MET-hrs/week) (n=1338; HR 0.88 [0.83, 0.93] P<0.0001) with stronger findings for lifestyle participants. Lifestyle had higher cumulative PA compared with metformin or placebo (p<0.0001) and higher accelerometry total minutes/day measured in follow-up (P=0.001 and 0.047). All associations remained significant with weight in the models. Conclusions: PA was inversely related to incident diabetes in the entire cohort across the study with cross-sectional accelerometry results supporting these findings. This highlights the importance of PA within lifestyle intervention efforts designed to prevent diabetes and urge health-care providers to consider both PA and weight when counseling high-risk patients.

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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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Revisiting the Fetal Assault Law in Tennessee: Implications and the Way Forward

Policy Politics & Nursing Practice ◽

10.1177/1527154421989994 ◽

2021 ◽

pp. 152715442198999

Author(s):

Caroline K. Darlington ◽

Peggy A. Compton ◽

Sadie P. Hutson

Keyword(s):

United States ◽

Health Care ◽

Drug Use ◽

Health Care Providers ◽

Well Being ◽

The United States ◽

Care Providers ◽

Opioid Use ◽

The Impact ◽

In Pregnancy

The rising prevalence of opioid use disorder (OUD) among those living in the United States has demanded a collaborative response from health care and policy spheres. Addressing OUD among pregnant women is especially difficult, given the controversies surrounding the medical and ethical balance between meeting maternal versus fetal/newborn needs. Most medical organizations discourage the criminalization of drug use in pregnancy due to the adverse public health outcomes of such an approach. Despite this recommendation, many states continue to use punitive law to address drug use in pregnancy. In 2014, the Fetal Assault Law in Tennessee (TN) became the first law in the United States to directly allow women to be prosecuted for drug use in pregnancy. Since its expiration in 2016, this law has been re-introduced several times to the TN legislature in support of permanent implementation. This article outlines the impact of the initial Fetal Assault Law on maternal/newborn health in TN and provides alternative immediate, short-term, and long-term health policy strategies through which health care providers and legislators can better advocate for the well-being of both mothers with OUD and their infants.

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Wales Inverse Care Law Programme - Design and Implementation of Routine Data Evaluation and Lessons Learned

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1517 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Ashley Akbari ◽

Rowena Griffiths ◽

Alice Puchades ◽

Sara Thomas

Keyword(s):

Health Care Providers ◽

Large Scale ◽

Routine Data ◽

Lessons Learned ◽

Health Check ◽

Final Report ◽

Care Providers ◽

Targeted Interventions ◽

Inverse Care Law ◽

The Impact

IntroductionThe Inverse Care Law (ICL) programme in Wales was setup to tackle health inequalities. Eligible populations from deprived communities, at higher risk of cardiovascular disease (CVD) were invited to a health-check and offered appropriate lifestyle and clinical interventions. Objectives and ApproachEvaluation of this programme is vital to ensure that targeted interventions have been received by those most in need, including referrals to lifestyle services and support. The use of longitudinal population-scale routine-data required the development of an approach which was both efficient and cost effective. To achieve this, the Welsh Longitudinal General Practice (WLGP) data held in SAIL Databank was utilised. A programme-specific methodology was agreed by the programme-board and developed so that data collected from GP records prior, during and post health-check accurately identified the eligible population and allowed the effective assessment of lifestyle and clinical risk factors for CVD; poor diet, physical inactivity, smoking and high alcohol intake, so appropriate interventions could be offered. ResultsWe evaluated the programme from 2015 to 2019 in 70 GP’s across the participating Health-Boards, and identified 175,671 individuals eligible by the programme criteria. Substantial preliminary work has been carried out to ensure the specification of outcome measures are both clinically and epidemiologically accurate and relevant. The final report scheduled for release in August-2020, which will evaluate the impact of the programme. Conclusion / ImplicationsThis ambitious evaluation of a large-scale programme set in the community involving disparate systems and a range of stakeholders, has been both complex and challenging, requiring substantial effort to design and implement. We hope the outcomes and lessons learned from our experience will improve the design, implementation and evaluation of the programme and lead to improvements in services and the quality of life for people in Wales, and provide an exemplar for health care providers worldwide wishing to conduct similar programmes in the future.

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The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

10.2337/figshare.13103333 ◽

2020 ◽

Author(s):

Andrea M. Kriska ◽

Bonny Rockette-Wagner ◽

Sharon L. Edelstein ◽

George A. Bray ◽

Linda M. Delahanty ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Prevention ◽

Cox Proportional Hazards ◽

Lessons Learned ◽

Diabetes Incidence ◽

Care Providers ◽

Cross Sectional ◽

Entire Cohort ◽

The Impact

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Rapid Project Management in a Time of COVID-19 Crisis: Lessons learned from a Global VIRUS: COVID-19 Registry (Preprint)

10.2196/preprints.27921 ◽

2021 ◽

Author(s):

Janice R. Turek ◽

Vikas Bansal ◽

Aysun Tekin ◽

Mayank Sharma ◽

Marija Bogojevic ◽

...

Keyword(s):

Health Care ◽

Critical Care ◽

Project Management ◽

Health Care Providers ◽

Large Scale ◽

Lessons Learned ◽

Care Providers ◽

Healthcare Organizations ◽

Collect Patient Data ◽

The Impact

UNSTRUCTURED The COVID-19 pandemic emerged globally in a rapid and precipitous manner devastating healthcare organizations worldwide. The progression of the illness, the impact to the vulnerable and best care for the hospitalized patient, is undefined. Incomplete knowledge of best practices by frontline health care providers may result in error-prone care. Data on symptoms and advancement of the SARS-CoV-2 virus leading to critical care admission has not been captured or communicated well between international organizations experiencing the same impact from the virus. As the SARS-CoV-2 virus quickly reached every country, it was recognized that global communication and data collection on the critical care patients admitted with COVID-19 needed to be rapidly put in place. Developing a global registry to collect patient data and treatment in the critical care setting was of utmost priority with the goal to minimize preventable death, disability, and costly complications for patients with COVID-19. Project management around the prompt implementation of the registry is crucial. Valuable information could be lost daily without a format to record data and the opportunity to share significant findings. Putting the VIRUS: COVID-19 Registry in place could change patient outcomes by gaining insight to progression of symptoms and treatments worldwide. This article addresses project management lessons in a time of crises outlining the methodology used and is meant to be a useful tool for other organizations for rapid project management for a large-scale health care data registry.

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