Preconception health services for women with opioid use disorder (OUD): A review and best practice recommendation.

2021 ◽  
Author(s):  
Jennifer K. Bello ◽  
Catherine Baxley ◽  
Jeremiah Weinstock
Keyword(s):  
Health Services ◽  
Best Practice ◽  
Opioid Use Disorder ◽  
Preconception Health ◽  
Opioid Use ◽  
Practice Recommendation

scholarly journals Integrating Psychological Services Into Community-Based Clinics

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 527-527
Author(s):  
Lindsey Jacobs
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Behavioral Health ◽  
Behavioral Health Care ◽  
Opioid Use Disorder ◽  
Current Status ◽  
Mental Health Stigma ◽  
Behavioral Health Services ◽  
Opioid Use ◽  
Integrated Behavioral Health

Abstract In Alabama, where mental health stigma is a critical barrier to care, integrated behavioral health services are vital to address the mental health needs that underlie substance use disorder (SUD) and opioid use disorder (OUD). Since October 2019, our team has developed partnerships with one rural and two peri-urban primary care clinics to offer behavioral health services with an emphasis on SUD/OUD prevention, screening, and treatment. The patient populations receiving services at these three facilities are under-resourced with multiple disadvantages placing them at risk for morbidity, mortality, SUD/OUD, and poor behavioral and mental health outcomes. Behavioral health services have been delivered primarily via telehealth due to the COVID-19 pandemic. This presentation will describe the process, current status, and future goals for implementing integrated behavioral health care, with a focus on identifying the barriers and facilitators during the COVID-19 pandemic era.

scholarly journals Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire

2020 ◽  
Vol 1 ◽  
pp. 263348952094885
Author(s):  
Allyson L Varley ◽  
Burel R Goodin ◽  
Heith Copes ◽  
Stefan G Kertesz ◽  
Kevin Fontaine ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Best Practice ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
High Quality Research ◽  
Practice Recommendations ◽  
Factors Influencing ◽  
Item Questionnaire

Background: Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) capacity to deliver high quality, research-informed care for this population is unknown. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. Methods: Capacity to Treat Co-Occurring Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire items were developed over a 2-year process including literature review, semi-structured interviews, and expert panel review. In 2018, a national sample of 509 PCPs was recruited through email to complete a questionnaire including the initial 44-item draft CAP-POD questionnaire. CAP-POD items were analyzed for dimensionality, inter-item reliability, and construct validity. Results: Principal component analysis resulted in a 22-item questionnaire. Twelve more items were removed for parsimony, resulting in a final 10-item questionnaire with the following 4 scales: (1) Motivation to Treat patients with chronic pain and OUD (α = .87), (2) Trust in Evidence (α = .87), (3) Assessing Risk (α = .82), and (4) Patient Access to therapies (α = .79). These scales were associated with evidence-based practice attitudes, knowledge of pain management, and self-reported behavioral adherence to best practice recommendations. Conclusion: We developed a brief, 10-item questionnaire that assesses factors influencing the capacity of PCPs to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. The questionnaire demonstrated good reliability and initial evidence of validity, and may prove useful in future research as well as clinical settings. Plain language abstract Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) ability to deliver high quality, research-informed care for this population is unknown. There are no validated instruments to assess factors influencing PCP capacity to implement best practices for treating these patients. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. We recruited 509 PCPs to participate in an online questionnaire that included 44 potential items that assess PCP capacity. Analyses resulted in a 10-item questionnaire that assesses factors influencing capacity to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. PCPs reported moderately high confidence in the strength and quality of evidence for best practices, and in their ability to identify patients at risk. However, PCPs reported low motivation to treat co-occurring chronic pain and OUD, and perceived patients’ access to relevant services as suboptimal, highlighting two areas that should be targeted with tailored implementation strategies. The 10-item Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire can be used for two purposes: (1) to assess factors influencing PCP capacity before implementation and identify areas that may require improvement for implementation and (2) to evaluate implementation interventions aimed at increasing PCP capacity to treat this population.

Comparative Analysis of State Level Health Policy Support for Opioid Abuse Mitigation in Rural America

2021 ◽  
pp. 137-161
Author(s):  
Carrie Shaver ◽  
James Johnson ◽  
Richard Greenhill ◽  
Sudha Nadimidla
Keyword(s):  
Public Health ◽  
Health Policy ◽  
Comparative Analysis ◽  
Best Practice ◽  
Financial Burden ◽  
State Level ◽  
Opioid Use Disorder ◽  
Policy Support ◽  
Rural America ◽  
Opioid Use

In rural America, opioid use disorder (OUD) continues to adversely impacted familial, public, and economic systems, creating extraordinary societal and financial burden. This comparative analysis of state-level public health policy and practices in rural opioid use abatement promotes the development and implementation of contextualized evidence-based comprehensive policy initiatives. Policy analysis across select highly affected states (Indiana, Kansas, Kentucky, and West Virginia) and exemplar OUD policy response states (Colorado, Massachusetts, Ohio, and Vermont) was performed using a systematic review of literature, legislation, plans, and policies. Findings included close alignment between states’ OUD policies and public health best practice standards; minimized differences between exemplar and highly affected states policy responses; and resource driven gaps in opioid epidemic legislation, regulation, guidelines, strategic plans, and initiatives. Furthermore, it is advocated that public and private stakeholders committed to health equity must seek reductions in opioid related disease and mortality through increased resource allocation.

Developing opioid prescribing recommendations in the postoperative orthopedic setting

2019 ◽  
Vol 15 (4) ◽  
pp. 333-341
Author(s):  
Daniel K. Haddad, PharmD ◽  
Orrin H. Sherman, MD
Keyword(s):  
Postoperative Pain ◽  
Best Practice ◽  
Opioid Analgesics ◽  
Postoperative Pain Management ◽  
The United States ◽  
Opioid Use Disorder ◽  
Prescribing Patterns ◽  
Opioid Use ◽  
High Quality Research ◽  
Opioid Prescribing

Background: The use of opioid analgesics in the United States has increased nearly fourfold since 1999 resulting in a similar increase in opioid-related overdose deaths. Although the Centers for Disease Control published guidelines for prescribing chronic opioids, there is a lack of guidance for prescribing postoperative opioids. Objective: To offer an evidence-based approach to prescribing opioids for postoperative pain management in the orthopedic setting.Methods: A narrative review was performed of studies evaluating and quantifying opioid use in orthopedic patients in the postoperative setting, as well as studies analyzing patient satisfaction and perception with regards to opioid use.Results: Studies show that postoperative pain may not be the largest contributing factor to developing an opioid use disorder, but rather patient factors such as tobacco and substance use disorder, mental health disorders, anxiety, mood disorders, pre-existing chronic pain, and recent opioid use may play a role. The review also found that most patients do not utilize significant portions of prescribed opioids and most do not require a refill. This trend leaves patients with thousands of unused pills, which are either retained, shared, or diverted. Although there is no guideline for prescribing opioids postoperatively, data suggest that clinicians can prescribe smaller dosages and fewer quantities of opioids initially. There are also non-opioid strategies that can be employed to reduce opioid consumption.Conclusion: There is a need for more high quality research to be conducted to standardize postoperative opioid prescribing patterns and create best practice guidelines to guide clinicians. Orthopedic practices should consider creating institutional guidelines to reduce the amount of opioids prescribed.

scholarly journals Increasing Access to Medications for Opioid Use Disorder and Complementary and Integrative Health Services in Primary Care

2020 ◽  
Vol 35 (S3) ◽  
pp. 918-926 ◽  
Author(s):  
Evelyn T. Chang ◽  
Rebecca S. Oberman ◽  
Amy N. Cohen ◽  
Stephanie L. Taylor ◽  
Elisa Gumm ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Integrative Health

scholarly journals Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Randi Sokol ◽  
Mark Albanese ◽  
Aaronson Chew ◽  
Jessica Early ◽  
Ellie Grossman ◽  
...  
Keyword(s):  
Conceptual Framework ◽  
Best Practice ◽  
Case Series ◽  
Implementation Strategies ◽  
Outpatient Setting ◽  
Opioid Use Disorder ◽  
Clinical Environment ◽  
Opioid Use ◽  
Opioid Treatment ◽  
Study Sites

Abstract Background Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical “how to” components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment? Methods To create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish “core” and “malleable” components, and provide a conceptual framework for considering various options for implementing the malleable components. Results We identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions. Conclusion While further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.

scholarly journals Improving Compliance with Best Practice Standards for Patients at Risk for Opioid Use Disorder

2020 ◽  
Author(s):  
Casey Williams
Keyword(s):  
Best Practice ◽  
Opioid Use Disorder ◽  
Evidence Based ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Post Intervention ◽  
Improvement Project ◽  
Care Plans ◽  
Opioid Use Disorders

Background: Available literature suggests that provider adherence to best practice guidelines regarding the prescribing and management of opioid therapies is low. Documentation of patient screening for present or future opioid use disorder is inconsistent. Provider incorporation of evidence-based guidelines into routine patient care is essential to optimizing outcomes related to opioid use disorders. Purpose/Specific Aims: The purpose of this scholarly project was to facilitate recognition of patients at high risk for opioid use disorders and facilitate best evidence based practices in the care of this population. Specific aims were to achieve provider compliance with: patient risk screening, PDMP review, completion of signed care plans, and reduction of inappropriate opioid prescriptions. Methods: A quasi-experimental design was used for this quality improvement project. The sample included patients receiving treatment for acute or chronic pain, or who were identified as having a substance use disorder. The project was conducted at an internal medicine practice in the northeast region. The intervention included an educational program addressing the ASAM guidelines and ORT utilization with implementation of a SmartPhrase in Epic. Baseline data was collected for the two-month period preceding the intervention and post-intervention data was collected for the three-month period following the intervention. Differences in pre- and post- intervention results were analyzed using chi square. Results: This project resulted in improved compliance with the implementation of urine toxicology screening, PDMP review, and completion of a controlled substance agreement. Compliance with ORT was not achieved. Conclusion: This project led to an increase in compliance with best opioid prescribing practices. The ORT was not consistently implemented; however, the number of new opioid prescriptions remained negligible. Additional efforts will be necessary to maintain the progress achieved in this project including attention to continued provider education. Real-time auditing and feedback will also be incorporated, and opportunities to involve office staff will be explored.

Changes In Health Services Use After Receipt Of Medications For Opioid Use Disorder In A Statewide Correctional System

2021 ◽  
Vol 40 (8) ◽  
pp. 1304-1311
Author(s):  
Benjamin A. Howell ◽  
Rosemarie A. Martin ◽  
Rebecca Lebeau ◽  
Ashley Q. Truong ◽  
Emily A. Wang ◽  
...  
Keyword(s):  
Health Services ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Health Services Use ◽  
Correctional System ◽  
Services Use
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