Background: Physical activity (PA) interventions may benefit youth with problematic substance use (SU); however, the acceptability of these interventions in young people is poorly understood. In this mixed-methods study, predictors and correlates of treatment acceptability of PA interventions as part of SU treatment were investigated, and young people's perspectives on PA intervention (e.g., perceived barriers and service-related needs) were explored.
Methods: Young people aged 16-25 years (n=145) with problematic SU completed a quantitative online survey on substance use, PA engagement, treatment acceptability, and perceived barriers and benefits of PA. Data were analysed using data mining and modelling approaches. Four participants aged 18-25 years participated in a subsequent, semi-structured focus group; data were analysed using qualitative content analysis. Quantitative and qualitative findings were integrated using an established model of behaviour change (COM-B).
Results: Generalised additive modelling identified perceived PA barriers to be a predictor of treatment acceptability (p≤.001). Decision tree analyses confirmed that lower psychological distress (1st partition, p<.001) and higher PA levels (2nd partition, p=.03) predicted lower perceived PA barriers. Latent class analysis suggested a 2-class model differentiating young people at moderate substance-related risk, reporting low psychological distress and perceived PA barriers (class 1) from young people at severe substance-related risk, reporting higher psychological distress and perceived barriers. Qualitative findings revealed substantial barriers to PA, including substance-related, mental health, access, and social barriers. Together, findings illustrated complex interactions between different dimensions related to behaviour change and areas where clinical services may increase young people's capability, opportunity and motivation to prompt behaviour change.
Conclusions: PA levels and psychological distress predict perceived barriers to PA in young people with problematic SU. PA barriers predict treatment acceptability of PA interventions. Knowledge of such predictors may inform treatment decisions by clinicians. Young people's insights should be integrated into PA intervention research to inform intervention and understand the unique barriers, preferences and needs of youth affected by problematic SU. Integration of young people's perspectives may increase behaviour change, as well as motivation, engagement and positive feelings in young people participating in PA interventions within substance use treatment.
Background: The HEALing Communities Study was a multi-site cluster randomized waitlist-controlled trial evaluating a community-engaged, data-driven intervention to select and deploy evidence-based practices (EBPs) including overdose education and naloxone distribution (OEND), medication for opioid use disorder (MOUD), and safer opioid prescribing. The trial was conducted in 67 highly impacted communities in 4 states, including 8 Rural and 8 urban communities in New York State (NYS). To inform future community-level decision making, we estimated the implementation costs of the EBPs selected by NYS communities.
Methods: The study was implemented between January 2020-June 2022 (Wave 1, 30 months duration including the peak COVID-19 emergency period) and July 2022-December 2023 (Wave 2, 18 months); each wave included 4 Rural and 4 urban NYS communities. We collected cost data prospectively using invoices, administrative records, and interviews with program staff and stakeholders. We then conducted a micro-costing analysis from the community perspective and compared costs from Waves 1 and 2.
Results: In both Waves, each community deployed on average 15 EBPs (range 8-25). EBP costs averaged $705,000 (range $320,000-$1.3 million) and $312,000 (range $39,200-$686,300) in Waves 1 and 2, respectively. In Wave 1, 25% of costs were allocated for OEND, 71% for MOUD, and 4% for safer prescribing, compared to 38% for OEND, 60% for MOUD, and 2% for safer prescribing in Wave 2. Average EBP costs per community were $147,600 (range $20,900-$374,000) for those in the OEND category, $345,400 (range $4,100-$1.1 million) for MOUD, and $16,400 (range $360-$105,500) for safer prescribing. Total EBP cost per capita in urban communities was $0.32 compared to $2.65 in Rural communities in Wave 1, and $0.41 urban communities compared to $0.65 in Rural communities in Wave 2.
Conclusions: The lower EBP costs in Wave 2 resulted from differences in EBP categories and specific EBPs selected and may also reflect differences in the duration of the intervention and the impact of the COVID-19 pandemic over time. Higher per capita costs in rural communities indicate that many costs were not directly related to the number of individuals served.
Background: Practical and motivational barriers can deter people from engaging in substance use disorder (SUD) treatment, even those who seek treatment. Care navigation is a psychosocial intervention that seeks to facilitate patients' timely access to care by identifying and intervening upon barriers. Few trials have tested the effectiveness of care navigation when embedding in real-world healthcare, and no trials have studied the process of implementing care navigation into clinical practice. This protocol describes a study that will evaluate whether care navigation can increase treatment engagement among patients seeking SUD treatment.
Methods: The Addressing Barriers to Care for Substance Use Disorder (ABC-SUD) study is a hybrid type I cluster-randomized effectiveness-implementation trial. It is conducted in a mental health access center of an integrated healthcare system in Washington state. Within this center, licensed mental health clinicians assess patient needs and use shared decision-making to establish SUD treatment plans for patients (usual care). This study tests whether an added care navigation intervention can improve patient engagement in SUD treatment. Care navigation begins after a treatment plan is made and provides up to 7 weeks of support focused on enhancing patient motivation to initiate and engage in treatment, problem-solving barriers (e.g., transportation logistics), and accommodating patient preferences (e.g., preferred language of care, cultural preferences). This trial uses a two period, two sequence crossover design. Clinicians are randomized to offer care navigation to patients during the first or second study period (i.e., clinicians are assigned to an initial study condition and switch conditions halfway through the trial). Care navigation is implemented with several strategies: leadership engagement, clinical workflow specifications, electronic health record (EHR) tools, training, performance improvement, and electronic learning collaborative. The primary outcome-obtained from EHRs and insurance claims-is engagement in SUD treatment, defined as ≥3 SUD treatment visits within 48 days of a treatment plan. This study uses standardized measures of implementation climate and outcomes to examine mechanisms with which the intervention strategies exert their impact on implementation and effectiveness outcomes.
Discussion: The ABC-SUD study will test whether care navigation improves SUD treatment engagement while concurrently generating information about its implementation in healthcare.
Trial registration: This study was prospectively registered at www.
Clinicaltrials: gov (NCT06729957) on December 9, 2024.
Background: Rural communities face significant barriers to accessing substance use disorder (SUD) treatment, resulting in gaps in care and increased rates of opioid-related overdose deaths. Hospital-based Addiction Consult Services (ACS) improve outcomes for patients with SUD, but rural hospitals often lack these services.
Case presentation: The Community Addiction Consult (CAC) service was established at a rural hospital in western Massachusetts to address this gap. CAC was designed by a community coalition comprised of a diverse cross-section of the community in which the hospital is based, using opioid-overdose data from the region to inform their decisions. Using a telehealth model, the CAC provided evidence-based treatments to support hospital staff treating patients with opioid use disorder (OUD) or requiring addiction-related care. From April 2023 through December 2023, the CAC provided 36 consults, facilitating increased access to medications for opioid use disorder (MOUD), and enhancing provider confidence in treating people who use drugs (PWUD) and initiating MOUD. An average of 22 patients received MOUD as inpatients monthly, and 11 emergency department patients received MOUD monthly. The CAC team also implemented training sessions, and an anti-stigma campaign to familiarize hospital staff with harm reduction principles and person-centered care strategies to foster a more supportive treatment environment for PWUD.
Conclusions: The Community Addiction Consult service demonstrates the feasibility and efficacy of a telehealth Addiction Consult Service model. Paired with staff trainings, such a model can bridge the gaps in rural addiction care. By leveraging local expertise and data-driven approaches, this model offers a scalable, equitable solution to improving access to substance use disorder treatment in rural settings.
Background: Hepatitis C infection (HCV) and opioid use disorder (OUD) are syndemic in the U.S., thus primary care providers (PCPs) who treat OUD by prescribing buprenorphine can play key roles to advance HCV elimination targets. We compared HCV screening and treatment among PCPs who do and do not prescribe buprenorphine in Washington (WA) State.
Methods: This study utilized a cross-sectional survey of PCPs in WA State, designed to characterize HCV care delivery practices and experiences/attitudes toward HCV. In this study, the independent variable was self-reported buprenorphine prescribing, and the main outcomes were (1) guideline-concordant HCV screening and (2) directly providing treatment for HCV. We used descriptive statistics to describe respondent characteristics. We used logistic regression to assess the association between buprenorphine prescribing status and HCV screening and treatment outcomes.
Results: Our sample included 73 PCPs, of whom 55% prescribe buprenorphine. We found that 25% of buprenorphine prescribers directly treated HCV. There was over a 2x greater relative odds that buprenorphine prescribers would correctly screen for HCV relative to non-prescribers (OR = 2.24; 95% CI: 0.67-8.18, p = .20) and a nearly 2.5x greater relative odds that they would treat HCV relative to non-prescribers (OR = 2.42; 0.72-9.61; p = .17), although both findings were not statistically significant.
Conclusion: In a sample of PCPs in WA state, buprenorphine prescribers compared to non-prescribers appear more likely to screen for and directly treat HCV, yet only a minority treat HCV. Interventions are needed to enhance HCV guideline-concordant care among these and all PCPs on the frontlines of caring for persons with OUD.
Background: Accessing opioid use disorder (OUD) treatment is difficult for individuals with unstable housing. This population often uses public libraries for computer and internet access, which could provide telehealth access to OUD treatment. Therefore, we developed a novel 12-week library-facilitated telehealth intervention study called "Bupe by the Book" (BBB) that uses library resources to facilitate initiation and retention in OUD treatment with buprenorphine.
Methods: The study is a partnership between the San Diego Public Library and a federally qualified healthcare center attached to a homeless shelter (Father Joe's Villages (FJV) Village Health Center). We co-designed a pilot randomized controlled trial to assess the feasibility and acceptability of a library-facilitated telehealth intervention in San Diego, California. The intervention is being evaluated for its feasibility and acceptability (library tele-buprenorphine uptake) by obtaining an estimate of the effect of the library telehealth arm of the intervention on buprenorphine treatment outcomes (primary outcome: buprenorphine uptake, i.e., a pharmacy pickup and taking the prescription 1 + times) and adherence (i.e., > 1 buprenorphine positive screens, ideally for 8 + weeks), compared to the control (standard care at the clinic) intervention. Individuals reporting homelessness and OUD (with or without other substance use) are eligible. Forty library patrons will be recruited via flyers, screened for eligibility, and referred to FJV Health Center for in-person initial buprenorphine treatment intake visits. Participants who complete intake are enrolled and randomized to the library-facilitated telehealth condition, which involves using library internet and computer resources for follow-up buprenorphine treatment appointments with the medical provider via library telehealth. In the control condition, participants do not use library telehealth for their buprenorphine care follow up appointments, but rather they go in-person to the clinic or per usual standard care protocols. Feasibility and acceptability of the library telehealth intervention and conduct of the randomized controlled trial are determined by the participants' use of the library telehealth intervention for buprenorphine treatment, and quantitative and qualitative measures assessing their perceptions of the library telehealth intervention, collected over a 12-week period.
Discussion: The design of this pilot study may support the adoption of library-facilitated telehealth treatment as a feasible and acceptable strategy to engage and retain people experiencing homelessness with OUD in buprenorphine treatment.
Trial registration: This trial was registered prospectively at ClinicalTrials.gov (registration number NCT05872386) on May 24, 2023.
Background: People with opioid use disorders (OUD) living in the South and Midwest are under-prescribed pre-exposure prophylaxis (PrEP) despite an increasing number of providers writing PrEP prescriptions in other regions of the United States. Greater research is needed into attitudes toward integrating harm reduction strategies into primary care and PrEP prescribing among prescribers working in rural primary care settings. The objective of this paper was to examine relationships between providers' attitudes toward buprenorphine and methadone, comprehensive harm reduction (e.g., fentanyl test strips) and self-reported PrEP prescribing in the past year.
Methods: Relationships were examined between attitudes toward buprenorphine and harm reduction services, and PrEP prescribing among 409 rural primary health care providers (PCPs) treating at least one person with OUD or HIV in several EHE priority states. A Qualtrics panel survey was administered to primary care providers residing in the U.S. South and Midwest and worked in a Federally Qualified Health Center, Rural Health Clinic or other HRSA-eligible health center. Chi-square tests were used to explore significant differences between PrEP prescribers and non-Prescribers on attitudes toward integrating MOUD, drug-related harm reduction into primary care.
Results: Overall, 62.1% (n = 254) of the sample of providers reported writing at least one prescription for PrEP in the past year. Providers who believed that reforming buprenorphine waiver laws made their jobs easier or who expressed interest in integrating naloxone distribution and syringe exchange into primary care were more likely to write prescriptions for PrEP compared to providers who did not have these beliefs. Providers who were from larger facilities and who had specialty training in infectious diseases were more likely to write prescriptions for PrEP.
Conclusions: Findings from this study suggest that providers who are more open to integrating harm reduction services into primary care are more likely to prescribe PrEP in the past year. PCPs with more positive attitudes toward naloxone, syringe exchange, and buprenorphine were more likely to prescribe PrEP in the past year. Combination interventions may be a promising avenue of reducing the harms of drug use including overdose and HIV infection among populations of people who use drugs.
Background: Routine use of brief, structured screening tools is essential to detect and provide support for Australians who drink above recommended levels. However, detecting drinking above recommended levels in Aboriginal and Torres Strait Islander Australian primary care settings is complex. Inaccuracies in completing a screening tool such as Alcohol Use Disorders Identification Test - Consumption, can lead to errors in estimating drinking in First Nations contexts where group sharing and episodic drinking make it difficult to accurately estimate alcohol consumption with tools that assume regular drinking patterns. This can lead to under-detection of drinking and a mismatch with the subsequent care that is offered. Hence, screening tools that consider these contextual factors are needed to make it easier for First Nations Australian primary care services to screen for alcohol consumption above recommended levels. Electronic screening tools offer the technical flexibility to consider the drinking contexts Furthermore, for sensitive topics such as alcohol and other drugs, computer-based screening in the general population has been shown to provide more accurate and comprehensive responses compared with face-to-face interviews.
Aim: To facilitate alcohol screening and brief intervention in First Nations Australian primary care settings by adapting the Grog App - a community survey tool validated in Aboriginal and Torres Strait Islander populations for use in primary care.
Methods: The project will use mixed-methods techniques across five study stages: 1 - Interest-holder consultation; 2 - technical development; 3 - re-validation and user interface acceptability; 4 - implementation in an Aboriginal and Torres Strait Islander primary care setting; 5 - acceptability study, six months after implementation.
Discussion: The project will produce a novel, culturally appropriate digital health tool and implementation resources to make it easier to conduct routine alcohol screening in primary care contexts for a priority population, which may lead to increased screening and alcohol care rates. It will also provide first-ever contextual data about implementation of new health service improvement strategy focused on an electronic alcohol consumption screening tool, which is lacking in peer-reviewed literature. This study will also provide an important evidence base for using continuous quality improvement as an implementation approach in primary care settings.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：