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- Access to Care (5)
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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 16 of 16 Research Studies DisplayedRains 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
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
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
Bunting AM, Dickson M, Staton M
Polysubstance use and re-incarceration in the 12-months after release from jail: a latent transition analysis of rural Appalachian women.
The purpose of this study was to: 1) identify the patterns of polysubstance use of rural Appalachian justice-involved women, 2) examine how women's participation in polysubstance use changed in the 12-months after initial release from jail, and 3) determine if changes in women's substance use patterns were correlated with re-incarceration during the 12-months of follow-up after release. The researchers randomly recruited 339 women with a recent history of substance use from three rural jails, and analyzed their substance use from baseline (in jail) to 6 and 12-months. The study found three latent classes: High Polysubstance/injection drug use (IDU) (36.3% baseline), Opioid/Benzo (Benzodiazepine) Involved Polysubstance Use (57.3% baseline), and Low Use (6.4% baseline). After release, and especially in the first 6 months, women transitioned to latent classes of reduced substance use and/or reduced injection drug use. Women who were re-incarcerated during follow-up were likely to remain engaged in, or transition to, the High Polysubstance/IDU class. The researchers concluded that a crucial period for changes in substance use lies in the six-months post-release.
AHRQ-funded; HS026120.
Citation: Bunting AM, Dickson M, Staton M .
Polysubstance use and re-incarceration in the 12-months after release from jail: a latent transition analysis of rural Appalachian women.
Am J Drug Alcohol Abuse 2022 May 4;48(3):356-66. doi: 10.1080/00952990.2021.1995402..
Keywords: Substance Abuse, Behavioral Health, Rural Health, Women
Holtrop JS, Mullen R, Curcija K
The balance between serving the community and the reality of treating opioid use disorder in rural primary care practices.
The purpose of this qualitative study was to investigate clinician and staff perceptions related to medication assisted treatment (MAT) for opioid use disorder, particularly buprenorphine treatment, in rural primary care practices. Staff members from rural 42 practices were interviewed. Although there was almost no provision of MAT, policies and procedures to reduce opioid prescribing were usually in place and many practices expressed interest in learning more to help their patients and local communities.
AHRQ-funded; HS025056.
Citation: Holtrop JS, Mullen R, Curcija K .
The balance between serving the community and the reality of treating opioid use disorder in rural primary care practices.
J Health Care Poor Underserved 2022; 33(1):253-67. doi: 10.1353/hpu.2022.0019..
Keywords: Opioids, Substance Abuse, Behavioral Health, Primary Care, Rural Health, Medication
Curcija K, Zittleman L, Fisher M
Does a rural community-based intervention improve knowledge and attitudes of opioid use disorder and medication-assisted treatment? A report from the IT MATTTRs study.
As part of the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study, this paper describes the implementation of community-based interventions developed by rural community members and researchers to increase awareness and to promote positive attitudes toward medication-assisted treatment (MAT) for opioid use disorder (OUD) and explores changes in community members' OUD and MAT knowledge and beliefs. Findings showed that partnering with local community members resulted in the successful development and implementation of community-based interventions, exposure to which was associated with OUD knowledge and beliefs. Locally-created interventions should be included in comprehensive approaches to stem the OUD epidemic.
AHRQ-funded; HS025065.
Citation: Curcija K, Zittleman L, Fisher M .
Does a rural community-based intervention improve knowledge and attitudes of opioid use disorder and medication-assisted treatment? A report from the IT MATTTRs study.
J Rural Health 2022 Jan;38(1):120-28. doi: 10.1111/jrh.12545..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication, Rural Health
Zittleman L, Curcija K, Nease DE
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation described the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado.
AHRQ-funded; HS025065.
Citation: Zittleman L, Curcija K, Nease DE .
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Ann Fam Med 2022 Jan-Feb;20(1):18-23. doi: 10.1370/afm.2757..
Keywords: Opioids, Rural Health, Primary Care, Substance Abuse, Behavioral Health, Training, Implementation, Medication
Nourjah P, Kato E
AHRQ Author: Nourjah P, Kato E
"One size does not fit all" and other lessons learned from grants for implementation of the AHRQ medication assisted treatment for opioid use disorder in rural primary care.
This article summarizes lessons learned from five AHRQ grants to implement Medication for Opioid Use Disorder (MOUD) in rural primary care practices. The experience of these projects suggests that recruiting providers in rural areas and engaging them to initiate and sustain provision of MOUD is very difficult. Implementation of MOUD in rural primary care is challenging but success is more likely if implementers are attentive to the needs of individual providers, are flexible and can tailor implementation to the local situation, and can provide on-going support.
AHRQ-authored.
Citation: Nourjah P, Kato E .
"One size does not fit all" and other lessons learned from grants for implementation of the AHRQ medication assisted treatment for opioid use disorder in rural primary care.
Subst Abus 2021;42(2):136-39. doi: 10.1080/08897077.2021.1891600..
Keywords: Implementation, Opioids, Substance Abuse, Primary Care, Rural Health, Medication
Cole ES, DiDomenico E, Green S
The who, the what, and the how: a description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America.
This study looked at the problems of treatment access for opioid use disorder (OUD) in rural areas within the United States. Providers must complete 8-24 hours of training to obtain the Drug Addiction Treatment Act (DATA) 2000 waiver to have the legal authority to prescribe buprenorphine. The authors executed 5 AHRQ-funded dissemination and implementation grants to study and address barriers to providing Medications for Opioid Use Disorder Treatment (MOUD), including psychosocial supports. Obtaining the DATA 2000 waiver was found to be just one component of meaningful treatment using MOUD, and there are other significant barriers that providers face daily. The researchers’ initiatives and common lessons learned across their grants are summarized and recommendations are offered how primary care providers can be better supported to expand access to MOUD across rural America.
AHRQ-funded.
Citation: Cole ES, DiDomenico E, Green S .
The who, the what, and the how: a description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America.
Subst Abus 2021;42(2):123-29. doi: 10.1080/08897077.2021.1891492..
Keywords: Opioids, Medication, Primary Care, Rural Health, Substance Abuse, Access to Care
Salvador JG, Bhatt SR, Jacobsohn VC
Feasibility and acceptability of an online ECHO intervention to expand access to medications for treatment of opioid use disorder, psychosocial treatments and supports.
This study examined acceptability and feasibility of an online Extensions for Community Healthcare Outcomes (ECHO) model intervention developed to support rural primary care clinics to expand treatment and is part of a larger study tracking the impact of participation in this ECHO on expansion of medications for opioid use disorder (MOUD) in rural primary care. Using qualitative interviews and post-session questionnaires across 27 rural clinics in New Mexico, findings suggested evidence of feasibility and acceptability of MOUD ECHO to support expansion of this treatment.
AHRQ-funded; HS025345.
Citation: Salvador JG, Bhatt SR, Jacobsohn VC .
Feasibility and acceptability of an online ECHO intervention to expand access to medications for treatment of opioid use disorder, psychosocial treatments and supports.
Subst Abus 2021;42(4):610-17. doi: 10.1080/08897077.2020.1806184..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication, Access to Care, Rural Health, Primary Care, Patient-Centered Healthcare
Kolak MA, Chen YT, Joyce S
Rural risk environments, opioid-related overdose, and infectious diseases: a multidimensional, spatial perspective.
The authors adapted a risk environment framework to characterize rural southern Illinois and to describe the relations of risk environments, opioid-related overdose, HIV, Hepatitis C, and sexually transmitted infection rates between 2015 and 2017. They identified pervasive risk hotspots in more populated locales with higher rates of overdose and HCV incidence, whereas emerging risk areas were isolated to more rural locales that had experienced an increase in analgesic opiate overdoses and generally lacked harm-reduction resources. They also found that at-risk areas were characterized with underlying socioeconomic vulnerability but in differing ways, reflecting a nuanced and shifting structural risk landscape.
AHRQ-funded; HS022433.
Citation: Kolak MA, Chen YT, Joyce S .
Rural risk environments, opioid-related overdose, and infectious diseases: a multidimensional, spatial perspective.
Int J Drug Policy 2020 Nov;85:102727. doi: 10.1016/j.drugpo.2020.102727..
Keywords: Rural Health, Opioids, Substance Abuse, Medication, Hepatitis, Risk, Behavioral Health
Zittleman L, Curcija K, Sutter C
Building capacity for medication assisted treatment in rural primary care Practices: the IT MATTTRs practice team training.
In response to rural communities and practice concerns related to opioid use disorder (OUD), the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study (IT MATTTRs) developed a training intervention for full primary care practice (PCP) teams in MAT for OUD. This evaluation reports on training implementation, participant satisfaction, and impact on perceived ability to deliver MAT.
AHRQ-funded; HS025065.
Citation: Zittleman L, Curcija K, Sutter C .
Building capacity for medication assisted treatment in rural primary care Practices: the IT MATTTRs practice team training.
J Prim Care Community Health 2020 Jan-Dec;11:2150132720953723. doi: 10.1177/2150132720953723..
Keywords: Medication, Primary Care, Opioids, Substance Abuse, Rural Health, Training, Education: Continuing Medical Education
Salvador J, Bhatt S, Fowler R
Engagement with Project ECHO to increase medication-assisted treatment in rural primary care.
The purpose of this study was to understand the barriers and facilitators that affect engagement with Project ECHO (Extension for Community Healthcare Outcomes) to implement medication-assisted treatment (MAT) in primary care settings. This brief report identified key systematic challenges that may directly limit primary care providers' engagement in telementoring models such as Project ECHO.
AHRQ-funded; HS025345.
Citation: Salvador J, Bhatt S, Fowler R .
Engagement with Project ECHO to increase medication-assisted treatment in rural primary care.
Psychiatr Serv 2019 Dec;70(12):1157-60. doi: 10.1176/appi.ps.201900142..
Keywords: Opioids, Medication, Substance Abuse, Primary Care, Rural Health, Telehealth, Health Information Technology (HIT)
Cochran G, Cole ES, Warwick J
Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers.
This paper reports the design and protocol of an implementation study seeking to advance availability of medication-assisted treatment (MAT) for opioid use disorder (OUD) in rural Pennsylvania counties for patients insured by Medicaid in primary care settings. Results showed an urgent need in the US to expand access to high quality, evidence-based OUD treatment, particularly in rural areas where capacity is limited for service delivery, in order to improve patient health and protect lives. Further, results of this study will provide needed evidence in the field for appropriate methods for implementing MAT among a large number of rural primary care providers.
AHRQ-funded; HS025072.
Citation: Cochran G, Cole ES, Warwick J .
Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers.
Addict Sci Clin Pract 2019 Aug 1;14(1):25. doi: 10.1186/s13722-019-0154-4..
Keywords: Opioids, Substance Abuse, Rural Health, Medication, Access to Care, Implementation, Primary Care, Healthcare Delivery, Medicaid
Cole ES, DiDomenico E, Cochran G
The role of primary care in improving access to medication-assisted treatment for rural Medicaid enrollees with opioid use disorder.
The authors examined the degree to which rural residents with opioid use disorder (OUD) are engaged with primary care providers (PCPs); they also described the role of rural PCPs in medication-assisted treatment (MAT) delivery, and estimated the association between enrollee distance to MAT prescribers and MAT utilization. They concluded that PCP utilization among rural Medicaid enrollees diagnosed with OUD is high, presenting a potential intervention point to treat OUD, particularly if the enrollee's PCP is located nearer than their MAT prescriber.
AHRQ-funded; HS025072.
Citation: Cole ES, DiDomenico E, Cochran G .
The role of primary care in improving access to medication-assisted treatment for rural Medicaid enrollees with opioid use disorder.
J Gen Intern Med 2019 Jun;34(6):936-43. doi: 10.1007/s11606-019-04943-6..
Keywords: Opioids, Substance Abuse, Rural Health, Medication, Access to Care, Implementation, Primary Care, Healthcare Delivery, Medicaid
Davis MM, Spurlock M, Dulacki K
Disparities in alcohol, drug use, and mental health condition prevalence and access to care in rural, isolated, and reservation areas: Findings from the South Dakota Health Survey.
The authors studied alcohol, drug use, and mental health (ADM) condition prevalence and access to care across diverse geographies in a predominantly rural state. They concluded that geographic disparities in ADM conditions are related to differences in access as opposed to prevalence, particularly for individuals in isolated and reservation areas.
AHRQ-funded; HS022981.
Citation: Davis MM, Spurlock M, Dulacki K .
Disparities in alcohol, drug use, and mental health condition prevalence and access to care in rural, isolated, and reservation areas: Findings from the South Dakota Health Survey.
J Rural Health 2016 Jun;32(3):287-302. doi: 10.1111/jrh.12157.
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Keywords: Disparities, Behavioral Health, Rural Health, Access to Care, Substance Abuse