National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 116 Research Studies DisplayedBui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Foot C, Korthuis PT, Tsui JI
Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder.
The objective of this secondary analysis of data from two clinical trials comparing buprenorphine and extended-release naltrexone was to estimate the effect of ongoing stimulant use on return to illicit opioid use after initiation of medication for opioid use disorder (MOUD). The findings indicated that people on medication for opioid use disorder who subsequently used stimulants appeared more likely to return to non-prescribed opioids use compared with those without stimulant use; this association appeared stronger among patients who initiated buprenorphine compared with those who initiated extended-release naltrexone.
AHRQ-funded; HS026370.
Citation: Foot C, Korthuis PT, Tsui JI .
Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder.
Addiction 2024 Jan; 119(1):149-57. doi: 10.1111/add.16334..
Keywords: Opioids, Substance Abuse, Medication, Behavioral Health
Goyal NK, Sood E, Gannon MA
Priorities for well child care of families affected by parental opioid use disorder.
This study’s objective was to explore priorities for well childcare (WCC) visit content for women in treatment with opioid use disorder to inform primary care recommendations for this population. Eligible participants had children 2 years or younger and were English speaking. Among the 30 parent participants, they were overwhelmingly White (83%) and unmarried (90%). Thirteen clinicians participated, of whom 9 were attending physicians. Interviews were conducted with parents and clinicians which led to five emerging themes: (1) improving knowledge and confidence related to child development, behavior, and nutrition; (2) mitigating safety concerns; (3) addressing complex health and subspecialty needs through care coordination; (4) acknowledging parental health and wellbeing in the pediatric encounter; and (5) supporting health education and care related to neonatal opioid withdrawal syndrome. These issues were expressed as hard to address by parents and clinicians due to time constraints, social determinants of health, and significant informational needs.
AHRQ-funded; HS027399.
Citation: Goyal NK, Sood E, Gannon MA .
Priorities for well child care of families affected by parental opioid use disorder.
J Addict Med 2024 Jan-Feb; 18(1):48-54. doi: 10.1097/adm.0000000000001243..
Keywords: Opioids, Substance Abuse, Behavioral Health, Caregiving, Children/Adolescents
Martwick J, Kaufmann J, Bailey S
Impact of healthcare location concordance on receipt of preventive care among children whose parents have a substance use and/or mental health diagnosis.
This study examined the association of children with parents with >1 substance use and/or other mental health (SU/MH) diagnoses and parent-child clinic concordance with rates of well-child checks (WCCs) and childhood vaccinations. This retrospective cohort study used electronic health record data from the OCHIN network of community health organizations (CHOs) from 2010 to 2018. This included 280 CHOs across 17 states and 41,413 parents with >1 SU/MH diagnosis linked to 65,417 children ages 0 to 17 years, each with >1 visit to an OCHIN clinic during the study period. The authors found that among children utilizing the same clinic as their parent versus children using a different clinic (reference group), there were greater WCC rates in the first 15 months of life; no difference in WCC rates in ages 3 to 17; higher odds for vaccine completion before age 2; and lower odds for vaccine completion before age 18.
AHRQ-funded; HS025962.
Citation: Martwick J, Kaufmann J, Bailey S .
Impact of healthcare location concordance on receipt of preventive care among children whose parents have a substance use and/or mental health diagnosis.
J Prim Care Community Health 2024 Jan-Dec; 15. doi: 10.1177/21501319241229925.
Keywords: Children/Adolescents, Prevention, Substance Abuse, Behavioral Health, Vaccination, Healthcare Utilization
Frimpong JA, Liu X, Liu L
AHRQ Author: Liu L
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
The purpose of this study was to explore the adoption of electronic health record (EHR) systems in substance use disorder (SUD) programs, with an emphasis on changes in adoption from 2014 to 2017, and identify organizational-level variables related with EHR adoption. The researchers utilized data from the 2014 and 2017 National Drug Abuse Treatment System Surveys, and analyzed 1,027 SUD programs. The study found the adoption of EHR increased significantly from 57.6% in 2014 to 69.2% in 2017. Nearly one-third of SUD programs had not yet adopted an EHR system by 2017. The researchers identified a significant increase in technology use and ownership by a parent company and a decrease in the percentage of uninsured patients in 2017 compared to 2014. Further analysis revealed significant differences by adoption status for three main barriers to adoption: 1. Costs of start-up, 2. Ongoing financial costs, and 3. Privacy or security concerns. Programs that used computerized scheduling and billing systems had a greater likelihood of adopting EHR. Ownership type, such as private nonprofit and public, or interest in taking part in a patient-centered medical home were related with a greater likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014.
AHRQ-authored.
Citation: Frimpong JA, Liu X, Liu L .
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
J Med Internet Res 2023 Dec 14; 25:e45238. doi: 10.2196/45238..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Substance Abuse, Behavioral Health
Rains A, Sibley AL, Levander XA
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
This study explored how people who use drugs in rural counties across the United States appraise sex work by themselves or other community members. The authors used qualitative interview data that came from the Rural Opioid Initiative (ROI), a project coordinated by research teams across 65 rural counties in 10 states. These interviews were individual and conducted from 2018 to 2020, with all participants reporting past 30-day opioid use and/or any injection drug use. Across sites, 355 interviews were conducted with a mean participant age of 36, 55% male, and 93% white. Negative attitudes were expressed towards sex work as a function of its criminal-legal repercussions or was framed as morally transgressive. Many appraisals were gendered, with the behavior described as being “easier” for women who were often described as "whores," with more neutral terms used to describe men. Some participants viewed sex work as an implicit “exchange” for drugs.
AHRQ-funded; HS026370.
Citation: Rains A, Sibley AL, Levander XA .
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
Int J Drug Policy 2023 Dec; 122:104237. doi: 10.1016/j.drugpo.2023.104237..
Keywords: Rural Health, Vulnerable Populations, Substance Abuse, Behavioral Health
Goyal N, Gannon M, Sood E
Group well child care for mothers with opioid use disorder: framework for implementation.
The purpose of this study was to utilize an implementation science framework to examine barriers and facilitators to group well child care (WCC) interventions for parents with opioid use disorder and their children. The researchers conducted a qualitative study using structured phone interviews as a component of the planning phase of a trial of group WCC. Eligible parents were English speaking and had a child less than two years old. Thirty-one parents and 13 pediatric clinicians participated in the interviews. 68% of parents reported that they would be likely or very likely to bring their child to the OUD treatment center for WCC. The researchers found 6 themes emerged describing perceived implementation barriers, including intervention difficulty, complexity, and potential negative outcomes including loss of privacy. Six themes emerged as implementation facilitators: 1. focus on parental OUD and recovery, 2. peer support, 3. accessibility and coordination of care, 4. clinician skill and expertise in parental OUD, 5. increased time for patient care, and 6. continuity of care.
AHRQ-funded; HS027399.
Citation: Goyal N, Gannon M, Sood E .
Group well child care for mothers with opioid use disorder: framework for implementation.
Matern Child Health J 2023 Dec; 27(suppl 1):75-86. doi: 10.1007/s10995-023-03762-w..
Keywords: Children/Adolescents, Women, Substance Abuse, Opioids, Behavioral Health
Liebschutz JM, Subramaniam GA, Stone R
Subthreshold Opioid Use Disorder Prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.
This article described the Subthreshold Opioid Use Disorder Prevention (STOP) Trial, a cluster randomized controlled trial designed to study the efficacy of the STOP intervention to reduce risky opioid use and to prevent progression to moderate/severe opioid use disorder (OUD) in adult primary care patients with subthreshold OUD. The STOP intervention consisted of a nurse care manager providing patient-participant education and primary care provider support, brief advice delivered to patient participants about health risks of opioid misuse, and up to six sessions of telephone health coaching to motivate and support behavioral change. The authors concluded that the STOP Trial offers a potential blueprint for feasible and effective improvement of outcomes for adult subthreshold OUD patients.
AHRQ-funded; HS026120.
Citation: Liebschutz JM, Subramaniam GA, Stone R .
Subthreshold Opioid Use Disorder Prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.
Addict Sci Clin Pract 2023 Nov 18; 18(1):70. doi: 10.1186/s13722-023-00424-8..
Keywords: Opioids, Substance Abuse, Behavioral Health, Prevention
Meiselbach MK, Huskamp HA, Eddelbuettel JCP
Choice of high-deductible health plans among enrollees with a substance use disorder.
Researchers examined factors associated with the decision of individuals with substance use disorders (SUDs) to enroll in high-deductible health plans (HDHPs). They used de-identified administrative commercial claims and enrollment data from OptumLabs to identify individuals at employers that offered at least one HDHP and one non-HDHP plan. Their findings showed that a health reimbursement arrangement was associated with a higher probability of new and re-enrollment in an HDHP. Older enrollees with SUD were less likely to enroll in a new HDHP, while enrollees who were non-White, lower income, and in lower educational attainment census blocks were more likely to newly enroll. The researchers concluded that, given the emerging evidence that HDHPs may discourage SUD treatment, higher HDHP enrollment could exacerbate health disparities.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Huskamp HA, Eddelbuettel JCP .
Choice of high-deductible health plans among enrollees with a substance use disorder.
J Subst Use Addict Treat 2023 Nov; 154:209152. doi: 10.1016/j.josat.2023.209152.
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Keywords: Health Insurance, Substance Abuse, Behavioral Health
Bridges NC, Taber R, Foulds AL
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
This study’s purpose was to gain a better understanding of the barriers and facilitators operating at multiple levels to access or provide medications for opioid use disorder (MOUD) in rural Pennsylvania. The authors interviewed patients and providers who were involved in the Rural Access to Medication Assisted Treatment in Pennsylvania (RAMP) Project, which facilitated adoption of MOUD in rural primary care clinics. The study conducted 35 semi-structured interviews with MOUD patients and MOUD providers participating in RAMP. The interviews were coded by the study team. Themes from the qualitative interviews were organized in five nested levels: individual, interpersonal, health care setting, community, and public policy. Patients and providers agreed on many barriers (such as lack of providers, lack of transportation, insufficient rapport and trust in patient-provider relationship, and cost, etc.); however, their interpretation of the barrier, or indicated solution, diverged in meaningful ways. Patients described their experiences in broad terms pointing to the social determinants of health while providers focused on their professional roles, responsibilities, and operations within the primary care setting.
AHRQ-funded; HS025072.
Citation: Bridges NC, Taber R, Foulds AL .
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
J Subst Use Addict Treat 2023 Nov; 154:209133. doi: 10.1016/j.josat.2023.209133..
Keywords: Rural Health, Rural/Inner-City Residents, Opioids, Medication, Substance Abuse, Behavioral Health, Primary Care
Dopp AR, Hunter SB, Godley MD
Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study.
This study’s goal was to compare organization-focused and state-focused financing strategies on their provider-level reach of a youth substance use treatment model. The authors evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing the two US federal grant mechanisms on organization-level A-CRA reach outcomes. Implementation of these A-CRA grants took place from 2006 to 2021. They used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, they calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding and also tested differences in certification rate by grant type. They also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. Overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants. They did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities).
AHRQ-funded; HS000046.
Citation: Dopp AR, Hunter SB, Godley MD .
Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study.
Implement Sci 2023 Oct 12; 18(1):50. doi: 10.1186/s13012-023-01305-z..
Keywords: Children/Adolescents, Substance Abuse, Behavioral Health
Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A
High-deductible health plans and nonfatal opioid overdose.
This study examined whether an employer offering a high-deductible health plan (HDHP) had an impact on nonfatal opioid overdose among commercially insured individuals with opioid use disorder (OUD) in the United States. The authors used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. They estimated the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. Across both groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. They found no association of HDHP with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD.
AHRQ-funded; HS000029.
Citation: Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A .
High-deductible health plans and nonfatal opioid overdose.
Med Care 2023 Sep; 61(9):601-04. doi: 10.1097/mlr.0000000000001886..
Keywords: Healthcare Costs, Health Insurance, Opioids, Substance Abuse, Behavioral Health
Somohano VC, Smith CL, Saha S
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
This article examined the role that trust in a prescribing provider has on shared decision-making and opioid misuse in opioid-specific pain management. A secondary analysis of data from a prospective cohort study was conducted of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator, such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant.
AHRQ-funded; HS026370.
Citation: Somohano VC, Smith CL, Saha S .
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
J Gen Intern Med 2023 Sep; 38(12):2755-60. doi: 10.1007/s11606-023-08212-5..
Keywords: Shared Decision Making, Opioids, Medication, Substance Abuse, Behavioral Health, Pain, Chronic Conditions
Button D, Levander XA, Cook RR
Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: a cross-sectional survey.
This study evaluated how technology access (cell phone use and access to the Internet) affected substance use disorder (SUD) treatment prior to COVID-19 for people who use drugs in rural areas. The authors used data from the Rural Opioid Initiative (January 2018-March 2020), which was a cross-sectional study of people with prior 30-day injection drug or nonprescribed opioid use from rural areas of 10 states. They found that out of 3,026 participants, 71% used heroin and 76% used methamphetamine with 35% having no cell phone and 10% having no prior 30-day Internet use. Having both a cell phone and the internet was associated with increased days of medication for opioid use disorder (MOUD) use and a higher likelihood of SUD counseling in the prior 30 days. Lack of cell phone was associated with decreased days of MOUD and a lower likelihood of prior 30-day SUD counseling.
AHRQ-funded; HS026370.
Citation: Button D, Levander XA, Cook RR .
Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: a cross-sectional survey.
J Rural Health 2023 Sep; 39(4):772-79. doi: 10.1111/jrh.12737..
Keywords: Substance Abuse, Behavioral Health, Rural Health, Telehealth, Health Information Technology (HIT), Opioids, Rural/Inner-City Residents
Miller-Rosales C, Busch SH, Meara ER
Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders.
This study examined the extent of screening for opioid use and availability of medications for opioid use disorder (MOUD) in a national cross-section of multi-physician primary care and multispecialty practices. The authors found that a total of 26.2% of practices offered MOUD, while 69.4% of practices screened for opioid use. Offering of MOUD in a practice was associated with having advanced HIT functionality, while access to on-site behavioral clinicians was positively associated with offering MOUD in adjusted models.
AHRQ-funded; HS024075.
Citation: Miller-Rosales C, Busch SH, Meara ER .
Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders.
Med Care Res Rev 2023 Aug; 80(4):410-22. doi: 10.1177/10775587231162681..
Keywords: Opioids, Substance Abuse, Behavioral Health, Screening, Medication, Practice Patterns
Bunting AM, Schwartz RP, Wu LT
A brief screening and assessment tool for opioid use in adults: results from a validation study of the Tobacco, Alcohol, Prescription Medication, and Other Substances Tool.
The objective of this secondary analysis was to evaluate opioid-specific validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substances (TAPS) tool for screening in primary care The findings showed that TAPS opioid items could be used in primary care settings for a spectrum of unhealthy opioid use; however, self-disclosure remains an issue in primary care settings. The researchers noted that further testing in a larger population sample might be warranted, given the brevity, simplicity, and accuracy of self-administration.
AHRQ-funded; HS026120.
Citation: Bunting AM, Schwartz RP, Wu LT .
A brief screening and assessment tool for opioid use in adults: results from a validation study of the Tobacco, Alcohol, Prescription Medication, and Other Substances Tool.
J Addict Med 2023 Jul-Aug; 17(4):471-73. doi: 10.1097/adm.0000000000001139..
Keywords: Opioids, Screening, Substance Abuse, Behavioral Health, Primary Care
Levander XA, Carmody T, Cook RR
A gender-based secondary analysis of the ADAPT-2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial.
This study’s objective was to determine if there were gender-based differences in treatment for methamphetamine use disorder (MUD) in general comparing treatment with placebo and due to use of a hormonal method of contraception (HMC). This research was a secondary analysis of ADAPT-2, a randomized, double-blind, placebo-controlled, multicenter, two-stage sequential parallel comparison design trial. This cohort study comprised 126 women (403 total participants); average age of 40.1 years with moderate to severe MUD. At baseline, women used methamphetamine intravenously fewer days than men [15.4 versus 23.1% days] and more women than men had anxiety (59.5 versus 47.6%). Of the 113 women capable of becoming pregnant, 31 used HMC. Treatment response for women was 29% in Stage 1 and 5.6% in Stage 2 compared with 3.2% and 0% on placebo, respectively. A treatment effect was found independently for females and males; with no between-gender treatment effect (0.144 females versus 0.100 males). Treatment effect did not differ by HMC use (0.156 HMC versus 0.128 none).
AHRQ-funded; HS026370.
Citation: Levander XA, Carmody T, Cook RR .
A gender-based secondary analysis of the ADAPT-2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial.
Addiction 2023 Jul; 118(7):1320-28. doi: 10.1111/add.16163..
Keywords: Substance Abuse, Medication, Behavioral Health, Sex Factors
Weiner SG, Lo YC, Carroll AD
The incidence and disparities in use of stigmatizing language in clinical notes for patients with substance use disorder.
The objective of this study was to evaluate the presence of stigmatizing language in clinical notes related to patients with substance use disorders and to detect patient- and provider-level differences. Results showed that the majority of patients with substance-related diagnoses had at least one note containing stigmatizing language. There were also several patient characteristic disparities associated with patients who had stigmatizing language in their notes. The author concluded that more clinician interventions about use of stigmatizing language are needed.
AHRQ-funded; HS026753.
Citation: Weiner SG, Lo YC, Carroll AD .
The incidence and disparities in use of stigmatizing language in clinical notes for patients with substance use disorder.
J Addict Med 2023 Jul-Aug; 17(4):424-30. doi: 10.1097/adm.0000000000001145..
Keywords: Disparities, Cultural Competence, Substance Abuse, Behavioral Health, Racial and Ethnic Minorities
King C, Beetham T, Smith N
Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022.
This study is a survey of US adolescent residential addiction treatment facilities to assess treatments used for adolescents younger than 18 years seeking treatment for opioid use disorder (OUD). The authors posed as an aunt or uncle of a 16-year-old with a recent non-fatal fentanyl overdose to make calls to treatment facilities more plausible if they did not have all requested information about an adolescent. Four investigators called facilities included in the SAMHSA Treatment Indicator in random order and asked to speak with someone about residential treatment. They asked specific questions about buprenorphine use and open-ended questions about other available treatments. They identified 354 facilities, reached 327, and confirmed that 160 provided residential treatment to patients younger than 18 years. Of the 160 facilities identified 39 (24.4%) offered buprenorphine, including through partnerships with outside clinicians. Rates varied by US region (18% in the West to 40% in the Northeast). Among the 121 facilities that did not offer buprenorphine or were unsure, 57 indicated that adolescents who were prescribed buprenorphine by their own clinician could continue receiving it, at least temporarily, although some facilities indicated that would discontinue it before discharged, and 22.3% required adolescents to not be receiving it at admission. Of 160 facilities, 140 had someone available who could prescribe medications for psychiatric comorbidities. Overall, 124 facilities had naloxone, 24 did not, and 11 were unsure. Over half of the facilities included family members in adolescent treatment. Leading approaches for adolescent treatment included mutual help frameworks (eg, 12-step program, n = 59), cognitive behavior therapy (n = 52), community reinforcement/adolescent community approach (n = 44), art therapy (n = 40), and equine therapy (n = 40).
AHRQ-funded; HS017589.
Citation: King C, Beetham T, Smith N .
Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022.
JAMA 2023 Jun 13; 329(22):1983-85. doi: 10.1001/jama.2023.6266..
Keywords: Children/Adolescents, Substance Abuse, Behavioral Health
Isbell LM, Chimowitz H, Huff NR
A qualitative study of emergency physicians' and nurses' experiences caring for patients with psychiatric conditions and/or substance use disorders.
This study’s aim was to develop a comprehensive data-driven model of the complex challenges and unique dynamics associated with caring for patients with psychiatric conditions and/or substance use disorders (SUDs) in the emergency department (ED), as well as the effect on patient care quality. The authors conducted a preplanned topical analysis of grounded theory data obtained from semistructured interviews with 86 ED physicians and nurses from 8 hospitals in the Northeastern USA. Participants described in detail their experiences and challenges in caring for patients with psychiatric conditions and/or SUDs. The authors identified themes inductively using constant comparative analysis and developed a grounded model of physicians' and nurses' perceptions of challenges, biases, and effects on patient care. Challenges identified were emotional, diagnostic, and logistical. These challenges magnified existing health care system issues and social structures, which fuel and reinforce negative attitudes, expectations, and biases. This creates a cyclical process whereby challenges and biases associated with patients with psychiatric conditions and/or SUDs can reciprocally threaten patient care quality.
AHRQ-funded; HS025752.
Citation: Isbell LM, Chimowitz H, Huff NR .
A qualitative study of emergency physicians' and nurses' experiences caring for patients with psychiatric conditions and/or substance use disorders.
Ann Emerg Med 2023 Jun; 81(6):715-27. doi: 10.1016/j.annemergmed.2022.10.014..
Keywords: Behavioral Health, Substance Abuse, Emergency Department, Provider: Nurse, Provider: Physician
Stiles-Shields C, Archer J, Zhang J
A scoping review of associations between cannabis use and anxiety in adolescents and young adults.
This review sought to examine the association between anxiety and cannabis in adolescents and young adults. Forty-seven studies were identified that examined the relationship between anxiety and cannabis use via a database search; 23 studies found a positive association that greater anxiety was associated with greater cannabis use and 7 found a negative association. The remainder found no clear association. The authors concluded that further research is needed to understand the relationship between anxiety and cannabis use.
AHRQ-funded; HS026385.
Citation: Stiles-Shields C, Archer J, Zhang J .
A scoping review of associations between cannabis use and anxiety in adolescents and young adults.
Child Psychiatry Hum Dev 2023 Jun; 54(3):639-58. doi: 10.1007/s10578-021-01280-w..
Keywords: Children/Adolescents, Anxiety, Substance Abuse, Behavioral Health
Short VL, Abatemarco DJ, Sood E
The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children.
Group-based well child care is a shared medical appointment where families join as a group to receive pediatric primary care. Prior research indicates that this method of receiving care increases patient-reported satisfaction and adherence to recommended care. There is little evidence supporting the use of group well child care for mothers with opioid use disorder. The purpose of the Child Healthcare at MATER Pediatric Study (CHAMPS) is to assess a group model of well child care for mothers with opioid use disorder and their children to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care. A total of 108 mother-child dyads will be enrolled into the study. In the intervention branch, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother-child dyads in the control branch will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study branches will be followed for 18 months, and their resulting data will be compared. Primary outcomes will include well child care quality and utilization, child health knowledge, and parenting quality.
AHRQ-funded; HS027399.
Citation: Short VL, Abatemarco DJ, Sood E .
The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children.
Trials 2023 May 17; 24(1):333. doi: 10.1186/s13063-023-07357-2..
Keywords: Children/Adolescents, Opioids, Substance Abuse, Behavioral Health
Sibley AL, Baker R, Levander XA
"I am not a junkie": social categorization and differentiation among people who use drugs.
The purpose of this qualitative study, framed by Social Identity Theory/Self-Categorization Theory, was to investigate strategies of within-group categorization and differentiation among people who use drugs (PWUD) and the roles these social categories play in shaping intragroup attitudes, perceptions, and behaviors. Data were taken from the Rural Opioid Initiative. Through interviews with participating PWUDs, researchers identified several facets of identity, behavioral and demographic, along which PWUDs perceived salient social boundaries. Patterns of categorization and differentiation revealed negative intragroup attitudes, including stigma, that may hinder collective action in this marginalized group.
AHRQ-funded; HS026370.
Citation: Sibley AL, Baker R, Levander XA .
"I am not a junkie": social categorization and differentiation among people who use drugs.
Int J Drug Policy 2023 Apr;114:103999. doi: 10.1016/j.drugpo.2023.103999.
Keywords: Substance Abuse, Behavioral Health, Social Stigma
Lee AK, Bobb JF, Richards JE
Integrating alcohol-related prevention and treatment into primary care: a cluster randomized implementation trial.
This study’s goal was to evaluate an implementation intervention to increase (1) population-based alcohol-related prevention with brief interventions and (2) treatment of alcohol use disorder (AUD) in primary care implemented with a broader program of behavioral health integration. This stepped-wedge cluster randomized trial called the Sustained Patient-Centered Alcohol-Related Care (SPARC) trial included 22 primary care practices in an integrated health system in Washington state. Participants consisted of all adult patients 18 years or older with primary care visits from January 2015 to July 2018. The study included 7 waves, with practices randomly assigned launch dates. A total of 333,596 patients visited primary care (mean age, 48 years; 193,583 [58%] female; 234,764 [70%] White individuals). The proportion of patients with brief intervention was higher during SPARC intervention than usual care periods (57 vs 11 per 10,000 patients per month). The proportion with AUD treatment engagement did not differ during intervention and usual care. However, it did increase intermediate outcomes: screening (83.2% vs 20.8%), new AUD diagnosis (33.8 vs 28.8 per 10,000), and treatment initiation (7.8 vs 6.2 per 10,000).
AHRQ-funded; HS023173.
Citation: Lee AK, Bobb JF, Richards JE .
Integrating alcohol-related prevention and treatment into primary care: a cluster randomized implementation trial.
JAMA Intern Med 2023 Apr;183(4):319-28. doi: 10.1001/jamainternmed.2022.7083.
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Patient-Centered Healthcare
Short VL, Gannon M, Sood E
Opportunities to increase well-child care engagement for families affected by maternal opioid use disorder: perceptions of mothers and clinicians.
The objectives of this qualitative study were to gather in-depth information regarding maternal and clinician-reported factors that facilitate or hinder well-child care (WCC) engagement as well as information from mothers' experiences during WCC visits. Thirty mothers in treatment for parental opioid use disorder (OUD) and 13 clinicians working at a pediatric primary care clinic participated by completing one telephone session which involved a brief questionnaire followed by a semi-structured interview. Facilitators identified by mothers and clinicians, included continuity of care, addressing material needs, and clinician OUD training and knowledge. Barriers to WCC included: stigma toward mothers with OUD, gaps in basic parenting knowledge, competing specialized health care needs, and insufficient time to address concerns.
AHRQ-funded; HS027399.
Citation: Short VL, Gannon M, Sood E .
Opportunities to increase well-child care engagement for families affected by maternal opioid use disorder: perceptions of mothers and clinicians.
Acad Pediatr 2023 Mar;23(2):425-33. doi: 10.1016/j.acap.2022.07.013.
Keywords: Children/Adolescents, Family Health and History, Opioids, Substance Abuse, Behavioral Health, Caregiving, Patient and Family Engagement