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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 311 Research Studies DisplayedLu A, Armstrong M, Alexander R
Trends in pediatric prescription-opioid overdoses in U.S. emergency departments from 2008-2020: an epidemiologic study of pediatric opioid overdose ED visits.
This study looked at trends in pediatric prescription-opioid overdose visits to the emergency room from 2008 to 2020. This retrospective epidemiological study used the 2008-2020 Nationwide Emergency Department Sample. National estimates were broken down by zip code, emergency department (ED) disposition, and hospital location/teaching status. The prescription-opioid overdose ED visits for patients from 0-17 years old in the United States decreased by 22% from 2008 to 2019, then increased by 12% in 2020. Most patients were discharged to home following their ED visit, however, from 2019 to 2020 there was a 42% increase in patients admitted. The overdose rates per 100,000 children were highest in the 0 to 1 and 12 to 17 age groups, with the 12 to 17 group increasing by 27% in 2020. The West saw an increase of 58% in 2019-2020 and the Midwest increased by 20%.
AHRQ-funded; HS029183.
Citation: Lu A, Armstrong M, Alexander R .
Trends in pediatric prescription-opioid overdoses in U.S. emergency departments from 2008-2020: an epidemiologic study of pediatric opioid overdose ED visits.
PLoS One 2024 Apr 17; 19(4):e0299163. doi: 10.1371/journal.pone.0299163..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Opioids, Substance Abuse, Emergency Department, Medication, Behavioral Health
Jones BLH, Geier M, Neuhaus
Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: a retrospective cohort study.
This study examined withdrawal symptoms from opioids when using low dose initiation (LDI) strategies with buprenorphine. The authors conducted a retrospective chart review of patients with opioid use disorder (OUD) using daily fentanyl who were prescribed 7-day or 4-day LDI at 2 substance use disorder treatment clinics in San Francisco. Withdrawal severity and precipitated withdrawal, defined as acute worsening of withdrawal symptoms immediately after taking buprenorphine, were extracted from chart documentation by two addiction medicine experts. There were 175 initiations in 126 patients, who had a mean age of 37, 71% male, 26% women, and 2% non-binary; 21% were Black, 16% Latino, and 52% white. Other characteristics were that 60% were unstably housed and 75% had Medicaid insurance. Substance co-use included 74% amphetamine use, 29% cocaine, 22% benzodiazepines, and 19% alcohol. They found deviation from protocol instructions in 22% of these initiations with follow up. Withdrawal symptoms were found in 31% of the cohort, including 21% with mild symptoms, 8% moderate and 2% severe. Precipitated withdrawal occurred in 8% of initiations with follow-up. Of those, 7 had deviation from protocol instructions, with 3 cases (3%) in which precipitated withdrawal occurred without protocol deviation.
AHRQ-funded; HS026383.
Citation: Jones BLH, Geier M, Neuhaus .
Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: a retrospective cohort study.
Harm Reduct J 2024 Apr 9; 21(1):80. doi: 10.1186/s12954-024-00998-9..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Ambulatory Care and Surgery
Clifton RL, Carson I, Dir AL
Who gets screened and who tests positive? Drug screening among justice-involved youth in a midwestern urban county.
A study of justice-involved youth assigned to probation in a midwestern urban county examined factors influencing drug screening (DS) practices. Results showed that males were more likely to be screened and to test positive than females. Older youth were less likely to be screened, while a higher number of charges increased the likelihood of screening. Youth with violent offenses were more likely to be screened than those with other offenses but less likely to test positive. These findings suggest that DS decisions are influenced by various factors, including demographics and offense types. However, these factors may not always correlate with actual substance use, raising questions about the appropriateness of using demographic or charge-based criteria for determining who gets screened.
AHRQ-funded; HS022681.
Citation: Clifton RL, Carson I, Dir AL .
Who gets screened and who tests positive? Drug screening among justice-involved youth in a midwestern urban county.
Health Justice 2024 Apr 5; 12(1):13. doi: 10.1186/s40352-024-00273-w..
Keywords: Children/Adolescents, Substance Abuse, Screening, Urban Health
Westafer LM, Beck SA, Simon C
Barriers and facilitators to harm reduction for opioid use disorder: a qualitative study of people with lived experience.
The purpose of this study was to identify patient-focused barriers and facilitators to harm reduction strategies in the Emergency department (ED). The researchers conducted semi-structured interviews with a convenience sample of 25 people in Massachusetts diagnosed with an opioid use issue. The study observed themes including accessibility of harm reduction supplies, lack of self-care resulting from withdrawal and feelings of hopelessness, the influence of stigma on the potential for using harm reduction practices, habit and knowledge, and the need for user-centered harm reduction programs.
AHRQ-funded; HS025701.
Citation: Westafer LM, Beck SA, Simon C .
Barriers and facilitators to harm reduction for opioid use disorder: a qualitative study of people with lived experience.
Ann Emerg Med 2024 Apr; 83(4):340-50. doi: 10.1016/j.annemergmed.2023.11.020..
Keywords: Opioids, Substance Abuse, Behavioral Health
Fredericksen RJ, Baker R, Sibley A
Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry.
Semi-structured interviews with 349 people who use drugs (PWUD) in rural U.S. areas revealed a high prevalence of concurrent stimulant and opioid use. Methamphetamine was the most common stimulant used (78%). Participants identified various reasons for co-use, including changes in drug markets, recreational goals, and practical goals like managing opioid overdose or withdrawal symptoms. Some also reported using stimulants for functional purposes, such as increasing energy and reducing pain to maintain employment. This study highlights the need for targeted education, harm reduction services, and treatment options specifically addressing combined opioid and stimulant use in rural areas.
AHRQ-funded; HS026370.
Citation: Fredericksen RJ, Baker R, Sibley A .
Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry.
Harm Reduct J 2024 Apr 1; 21(1):74. doi: 10.1186/s12954-024-00986-z..
Keywords: Opioids, Rural Health, Substance Abuse, Behavioral Health, Rural/Inner-City Residents
Bernstein EY, Bernstein TP, Trivedi S
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
This study looked at outcomes after initiation of medications for alcohol use disorder (MAUD), which are very underutilized. The primary outcome was a composite of all-cause mortality or return to hospital within 30 days of discharge. Secondary outcomes included the previous components separately, return to hospital for alcohol-related diagnoses, and primary care or mental health follow-up within 30 days of discharge. There were 6794 unique individuals representing 9834 alcohol-related hospitalizations (median [IQR] age, 54 years; 3205 hospitalizations among females [32.6%]; 1754 hospitalizations among Black [17.8%], 712 hospitalizations among Hispanic [7.2%], and 7060 hospitalizations among White [71.8%] patients). Of these, 2% of hospitalizations involved discharged MAUD initiation. Discharge MAUD initiation was associated with a 42% decreased incidence of the primary outcome (incident rate ratio, 0.58). These findings were consistent among secondary outcomes (eg, incident rate ratio for all-cause return to hospital, 0.56) except for mortality, which was rare in both groups. Discharge MAUD initiation was associated with a 51% decreased incidence of alcohol-related return to hospital.
AHRQ-funded; HS026215.
Citation: Bernstein EY, Bernstein TP, Trivedi S .
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
JAMA Netw Open 2024 Mar 4; 7(3):e243387. doi: 10.1001/jamanetworkopen.2024.3387..
Keywords: Medication, Alcohol Use, Substance Abuse, Behavioral Health, Outcomes, Hospital Discharge
Hughes PM, Easterly CW, Thomas K
North Carolina Medicaid system perspectives on substance use disorder treatment policy changes during the COVID-19 pandemic.
This study’s objective was to describe perspectives from stakeholders involved in North Carolina’s Medicaid system on substance use disorder (SUD) treatment policy changes during the COVID pandemic. Researchers conducted semi-structured interviews with state agency representatives, Medicaid managed care organizations and providers, as well as three focus groups of Medicaid beneficiaries with SUD. Responses indicated that policy changes such as telehealth and take-home methadone were overall considered beneficial; staffing shortages, however, remained a substantial barrier. The researchers concluded that the policy changes should be continued, but additional steps are needed to ensure payment parity for telehealth services.
AHRQ-funded; HS000032.
Citation: Hughes PM, Easterly CW, Thomas K .
North Carolina Medicaid system perspectives on substance use disorder treatment policy changes during the COVID-19 pandemic.
J Addict Med 2024 Mar-Apr; 18(2):e1-e7. doi: 10.1097/adm.0000000000001272..
Keywords: COVID-19, Medicaid, Substance Abuse, Behavioral Health, Policy
Bui 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)
Bradford W, Figgatt M, Scott KS
Xylazine co-occurrence with illicit fentanyl is a growing threat in the Deep South: a retrospective study of decedent data.
This retrospective review’s goal was to identify trends in xylazine prevalence in fentanyl among people who fatally overdosed from June 2019 through June 2023 in the Deep South. The review used autopsy data from Jefferson County Alabama on 165 decedents. The first identified xylazine-associated overdose was in June 2019, but became consistently prevalent since January 2021. All overdose cases were accompanied by fentanyl, and most (75.4%) involved poly-drug stimulant use. The average age of the decedents was 42.4, and most were white (58.8%) and male (68.5%), with 18.2% unhoused at the time of death.
AHRQ-funded; HS013852
Citation: Bradford W, Figgatt M, Scott KS .
Xylazine co-occurrence with illicit fentanyl is a growing threat in the Deep South: a retrospective study of decedent data.
Harm Reduct J 2024 Feb 20; 21(1):46. doi: 10.1186/s12954-024-00959-2..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication
King CA, Beetham T, Smith N
Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs.
This study examined adolescent residential addiction treatment facilities in the United States, and their accessibility and cost. The authors used the Substance Abuse and Mental Health Services Administration's treatment locator and search engine advertising data to identify 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. They called facilities while role-playing as the aunt or uncle of a sixteen-year-old child with a recent nonfatal overdose to inquire about policies and costs. A little over half (54.5%) had a bed immediately available. The mean wait time for a bed was 28.4 days among sites with a waitlist. Of the facilities that provided cost information, the mean cost of treatment per day was $878, with daily costs among for-profit facilities triple of nonprofit facilities. Half of facilities required up-front payments by noninsured patients, with a mean up-front cost of $28,731. They were unable to identify any facilities for adolescents in ten states or Washington, D.C.
AHRQ-funded; HS017589.
Citation: King CA, Beetham T, Smith N .
Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs.
Health Aff 2024 Jan; 43(1):64-71. doi: 10.1377/hlthaff.2023.00777..
Keywords: Children/Adolescents, Substance Abuse, Healthcare Costs, Access to Care
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
Hughes PM, Ostrach B, Tak CR
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
This study used State-level secondary data to examine the impact of North Carolina's 2017 STOP Act on opioid overdose deaths by race. The results showed that the opioid overdose death rate among the White population decreased following the STOP Act, but found no significant change among the Black/African American population. The authors concluded that these findings have implications for health equity and may inform the development of future substance use policies.
AHRQ-funded; HS000032.
Citation: Hughes PM, Ostrach B, Tak CR .
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
J Subst Use Addict Treat 2023 Dec; 155:209171. doi: 10.1016/j.josat.2023.209171..
Keywords: Opioids, Mortality, Substance Abuse, Policy
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
Huffstetler AN, Villalobos G, Brooks EM
The current state of alcohol screening and management in Virginia primary care practices: an evaluation of preventive service use.
This study used the recommendations of the US Preventive Services Task Force on screening and behavioral counseling for adults over 18 years for unhealthy alcohol use to examine the current state of alcohol screening and management in Virginia primary care practices. Clinicians were advised to use the following recommended screening instruments: the Alcohol Use Disorders Identification Test-Concise and or Single Alcohol Screening Question. Baseline data showed that clinicians appropriately screened only 10.8% of patients and only identified 9.6% as having risky drinking. However, 24% of patients reported risky drinking on a survey, demonstrating the implementation gap of the USPSTF recommendation and opportunity to improve health.
AHRQ-funded; HS027077.
Citation: Huffstetler AN, Villalobos G, Brooks EM .
The current state of alcohol screening and management in Virginia primary care practices: an evaluation of preventive service use.
Med Clin North Am 2023 Nov; 107(6s):e1-e17. doi: 10.1016/j.mcna.2023.07.001..
Keywords: U.S. Preventive Services Task Force (USPSTF), Alcohol Use, Screening, Substance Abuse, Behavioral Health, Primary Care, Evidence-Based Practice
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
Hughes PM, Ramage M, Gigli KH
Assessing the cost-effectiveness of removing supervision requirements for nurse practitioners prescribing buprenorphine for opioid use disorder.
The purpose of this study was to evaluate the cost-effectiveness of full practice authority relative to restricted scope of practice for nurse practitioners (NPs) who intend to prescribe buprenorphine for opioid use disorder before implementation of the Mainstreaming Addiction Treatment Act and the Medication Access and Training Expansion Act (MAT/MATE) Acts. The study also examined scenarios modeling various implementations of MAT/MATE. A simulated cohort of 10,000 NPs went through a decision tree model with a 1-year time horizon. The results indicated that adoption of full practice authority for NPs may be cost-effective for increasing the available workforce for substance use treatment and for increasing the number of patients receiving buprenorphine.
AHRQ-funded; HS000032.
Citation: Hughes PM, Ramage M, Gigli KH .
Assessing the cost-effectiveness of removing supervision requirements for nurse practitioners prescribing buprenorphine for opioid use disorder.
J Nurs Regul 2023 Oct; 14(3):44-54. doi: 10.1016/S2155-8256(23)00112-6..
Keywords: Opioids, Substance Abuse, Behavioral Health, Provider: Nurse, Policy, Healthcare Costs
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