scholarly journals Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study (Preprint)

2018 ◽  
Author(s):  
Ross Murtagh ◽  
Davina Swan ◽  
Eileen O'Connor ◽  
Geoff McCombe ◽  
John S. Lambert ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Baseline Data ◽  
Substitution Treatment ◽  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
Opioid Substitution Treatment ◽  
Hcv Screening ◽  
Clinical Records ◽  
Opioid Substitution

BACKGROUND Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Injection drug use is now one of the main routes of transmission of HCV in Ireland and globally with an estimated 80% new infections occurring among people who inject drugs (PWID). OBJECTIVE We aimed to examine whether patients receiving opioid substitution therapy in primary care practices in Ireland were receiving guideline-adherent care regarding HCV screening. Ireland has developed a model of care for delivering opioid substitution treatment in the primary care setting. We conducted this study given the shift of providing care for PWID from secondary to primary care settings, in light of current guidelines aimed at scaling up interventions to reduce chronic HCV infection and associated mortality. METHODS We included baseline data from the Dublin site of the Heplink study, a feasibility study focusing on developing complex interventions to enhance community-based HCV treatment and improve the HCV care pathway between primary and secondary care. We recruited 14 opioid substitution treatment-prescribing general practices that employed the administration of opioid substitution therapy from the professional networks and databases of members of the research consortium. A standardized nonprobability sampling framework was used to identify 10 patients from each practice to participate in the study. Patients were eligible if aged ≥18 years, on opioid substitution treatment, and attending the practice for any reason during the recruitment period. The baseline data were collected from the clinical records of participating patients. We collected and analyzed data on demographic characteristics, care processes and outcomes regarding HCV and other blood-borne viruses, urinalysis test results, alcohol use disorders, chronic illness, and health service utilization. We examined whether patients received care concordant with guidelines related to HCV screening and care. RESULTS The baseline data were collected from clinical records of 134 patients; 72.2% (96/134) were males; (mean age 43, SD 7.6; range 27-71 years); 94.8% (127/134) of patients had been tested for anti-HCV antibody in their lifetime; of those, 77.9% (99/127) tested positive. Then, 83.6% (112/134) of patients had received an HIV antibody test in their lifetime; of those, 6.3% (7/112) tested HIV positive. Moreover, 66.4% (89/134) of patients had been tested for hepatitis B virus in their lifetime and 8% (7/89) of those were positive. In the 12 months before the study, 30.6% (41/134) of patients were asked about their alcohol use by their general practitioner, 6.0% (8/134) received a brief intervention, and 2.2% (3/134) were referred to a specialist addiction or alcohol treatment service. CONCLUSIONS With general practice and primary care playing an increased role in HCV care, this study highlights the importance of prioritizing the development and evaluation of real-world clinical solutions that support patients from diagnosis to treatment completion.

scholarly journals Breastfeeding and Opiate Substitution Therapy: Starting to Understand Infant Feeding Choices

2016 ◽  
Vol 10s1 ◽  
pp. SART.S34553 ◽  
Author(s):  
Lisa E. Graves ◽  
Suzanne Turner ◽  
Maya Nader ◽  
Sucheta Sinha
Keyword(s):  
Health Care ◽  
Infant Feeding ◽  
Health Care Professionals ◽  
Provider Education ◽  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
Opioid Substitution Treatment ◽  
Ovid Medline ◽  
Feeding Choices ◽  
Opioid Substitution

Introduction Despite research demonstrating the safety and benefit of breastfeeding in opioid substitution therapy, few women in treatment breastfeed. Understanding the factors contributing to the choices women on opioid substitution therapy make about infant feeding is important. Objectives The aim of this study was to better understand and support infant feeding choices and breastfeeding experiences in women on opioid substitution therapy. Methods A systematic review was conducted on five databases: (1) Ovid MEDLINE(R) without revisions, (2) Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, (3) EMBASE, (4) CINAHL, and (5) FRANCIS. From 1081 articles, 46 articles were reviewed. Results The literature supports breastfeeding as an appropriate and safe option for women on opioid substitution treatment. Breastfeeding and rooming-in reduce neonatal abstinence. Women face barriers to breastfeeding due to societal stigma and the lack of patient and health-care provider education. Conclusions Efforts are needed to increase the knowledge that women and health-care professionals have about the safety and benefits of breastfeeding.

scholarly journals How do people who use drugs experience treatment? A qualitative analysis of views about opioid substitution treatment in primary care (iCARE study)

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042865
Author(s):  
Paula Cristina Gomes Alves ◽  
Fiona A Stevenson ◽  
Sophie Mylan ◽  
Nuno Pires ◽  
Adam Winstock ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Service ◽  
Treatment Plan ◽  
People Who Use Drugs ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
Individual Interviews ◽  
Care Services ◽  
Primary Care Services ◽  
Opioid Substitution

ObjectiveTo understand the most significant aspects of care experienced by people in opioid substitution treatment (OST) in primary care settings.DesignSemistructured individual interviews were conducted, following the critical incidents technique. Interview transcripts were analysed following a thematic analysis approach.ParticipantsAdults aged 18 years or older, receiving OST in UK-based primary care services.ResultsTwenty-four people in OST were interviewed between January and March 2019. Participants reported several aspects which were significant for their treatment, when engaging with the primary care service. These were grouped into 10 major themes: (1) humanised care; (2) individual bond/connection with the professional; (3) professionals’ experience and knowledge; (4) having holistic care; (5) familiarity; (6) professionals’ commitment and availability to help; (7) anonymity; (8) location; (9) collaborative teamwork; and (10) flexibility and changes around the treatment plan.ConclusionsThis study included first-hand accounts of people who use drugs about what supports them in their recovery journey. The key lessons learnt from our findings indicate that people who use drugs value receiving treatment in humanised and destigmatised environments. We also learnt that a good relationship with primary care professionals supports their recovery journey, and that treatment plans should be flexible, tailor-made and collaboratively designed with patients.

scholarly journals Uptake of hepatitis C virus screening and treatment in persons under opioid substitution therapy between 2008 and 2013 in Belgium

2021 ◽  
Vol 84 (2) ◽  
pp. 311-316
Author(s):  
D Busschots ◽  
A Arain ◽  
R Bielen ◽  
Ö.M. Koc ◽  
L Bruckers ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
The Other ◽  
Hcv Rna ◽  
Insurance Fund ◽  
Health Insurance Fund ◽  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
Hcv Screening ◽  
Opioid Substitution

Background: Hepatitis C is a viral infection caused by the hepatitis C virus (HCV) with people who inject drugs as the main group at risk worldwide. Aim: This study investigated the differences in uptake for HCV screening and treatment between persons in opioid substitution therapy (OST) and the other members of the Christian Health Insurance Fund in Belgium. Methods: Invoice data were retrospectively collected from the Christian Health Insurance Fund, representing 42% of the healthcare users. Information on demographics, screening, diagnostic tests, treatment and disease progression was obtained from 2008 till 2013. All people in this study were aged 20-65 year. Persons in the OST group were identified as having at least one prescription reimbursed for methadone. This group was compared to the other members of the Insurance Fund not on OST (NOST). Results: The Insurance Fund registered 8,409 unique OST and 3,525,190 members in the general group. HCV RNA screening rate was higher in the OST group after correction for age and gender (4.3% vs. 0.2%). Ribavirin reimbursement, did not differ between the OST and NOST group screened for HCV RNA (16.9% vs. 14.4%), though the probability of having ribavirin reimbursed was smaller for females than for males. Procedures concerning disease progression were reimbursed less frequently in the HCV RNA screened OST group compared to the NOST group (0.3% vs. 1.2%). Conclusion: People on OST were screened more often for HCV RNA. However, the general uptake for HCV screening and treatment in both populations remained suboptimal.

scholarly journals Waiting room ambience and provision of opioid substitution therapy in general practice

2012 ◽  
Vol 196 (6) ◽  
pp. 391-394 ◽  
Author(s):  
Simon M Holliday ◽  
Parker J Magin ◽  
Janet S Dunbabin ◽  
Ben D Ewald ◽  
Julie‐Marie Henry ◽  
...  
Keyword(s):  
General Practice ◽  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
Waiting Room ◽  
Opioid Substitution

scholarly journals Collaborative Video Consultations from Tertiary Care Based Telepsychiatrist to a Remote Primary Care Doctor to Manage Opioid Substitution Therapy Clinic

2020 ◽  
Vol 11 (03) ◽  
pp. 498-501
Author(s):  
Erika Pahuja ◽  
Santosh Kumar ◽  
Ajay Kumar ◽  
Fareed Uzzafar ◽  
Siddharth Sarkar ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Primary Care Doctor ◽  
Psychiatric Training ◽  
High Morbidity ◽  
Opioid Use ◽  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
Opioid Substitution ◽  
Collaborative Video

AbstractOpioid use is a major problem in India and has high morbidity and mortality with a prevalence of 2.06%. There is a huge treatment gap for opioid use disorders (OUDs). Due to limited mental health resources and limited psychiatric training of medical practitioners in OUDs, a significant proportion of patients do not receive appropriate medical intervention. This article demonstrates how a primary care doctor working in a remote opioid substitution therapy (OST) clinic received assistance from the optional opioid module of clinical schedule for primary care psychiatry (CSP) and collaborative video consultation (CVC) module to address specific difficulties of patients already on Buprenorphine OST and improve the quality of care, thereby reducing chances of relapses. CVC module is a part of one-year digitally driven primary care psychiatry program designed by National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. The opioid module was designed by NIMHANS, Bengaluru in collaboration with the All India Institute of Medical Sciences (AIIMS), New Delhi These observations warrant replication of this approach across diverse settings and at a larger scale to explore and evaluate its impact and effectiveness.

Integrating Hepatitis C Care for opioid substitution treatment patients attending general practice: Feasibility, Clinical and Cost Effectiveness (Preprint)

2021 ◽  
Author(s):  
Geoff McCombe ◽  
Davina Swan ◽  
John S Lambert ◽  
Eileen O’Connor ◽  
Zoe Ward ◽  
...  
Keyword(s):  
General Practice ◽  
Cost Effectiveness ◽  
Hepatitis C ◽  
Complex Intervention ◽  
Substitution Treatment ◽  
Hcv Treatment ◽  
Post Intervention ◽  
Opioid Substitution Treatment ◽  
Clinical Support ◽  
Opioid Substitution

BACKGROUND Hepatitis C (HCV) infection is common among people who inject drugs (PWID), yet well described barriers mean that a minority have accessed HCV treatment. OBJECTIVE The aim of this study was to examine feasibility, acceptability, clinical and cost effectiveness of an integrated model of HCV care for opioid substitution treatment (OST) patients in general practice. METHODS A pre-and-post intervention design with an embedded economic analysis was used to establish the feasibility, acceptability, clinical and cost effectiveness of a complex intervention to optimise HCV identification and linkage to HCV treatment among patients prescribed methadone in primary care. The ‘complex intervention’ comprised General Practitioner (GP) / practice staff education, nurse-led clinical support, and enhanced community-based HCV assessment of patients. General practices in North Dublin were recruited from the professional networks of the research team and from GPs who attended educational sessions. RESULTS Fourteen practices, 135 patients participated. Follow-up data was collected six-months post-intervention on 131(97.0%) patients. With regards to clinical effectiveness, among HCV antibody-positive patients, there was a significant increase in the proportions of who had a liver fibroscan (17/101(16.8%) vs 52/100 (52.0%); p<0.001), had attended hepatology/infectious diseases services (51/101(50.5%) vs 61/100 (61.0%); p=0.002), and initiated treatment (20/101(19.8%) vs 30/100 (30.0%); p=0.004). The mean incremental cost-effectiveness ratio of the intervention was €13,255 per quality adjusted life year gained at current full drug list price (€39,729 per course), which would be cost saving if these costs are reduced by 88%. CONCLUSIONS The complex intervention involving clinical support, access to assessment and practitioner education has the potential to enhance patient care, improving access to assessment and treatment in a cost effective manner.

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