Addiction Science & Clinical Practice最新文献

{"title":"Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: an updated systematic review.","authors":"Kathleen K Adams, Kristin Waters, Diana M Sobieraj","doi":"10.1186/s13722-025-00548-z","DOIUrl":"10.1186/s13722-025-00548-z","url":null,"abstract":"<p><strong>Background: </strong>Withdrawal prior to buprenorphine initiation may be intolerable or create barriers to therapy. We aim to update our previous systematic review on the efficacy and safety of buprenorphine initiation strategies that aim to omit prerequisite opioid withdrawal (POW).</p><p><strong>Methods: </strong>We used the same search strategy for this update as in the original review with the modification of an additional term \"low dose.\" We searched Embase and Scopus from April 11, 2020 to August 1, 2024 with searches in Google Scholar and www.</p><p><strong>Clinicaltrials: </strong>gov . A study was included if it described patients with opioid use disorder or chronic pain that transitioned from a full mu-opioid agonist to buprenorphine without preceding withdrawal and reported withdrawal during initiation as an outcome. Two investigators independently screened citations and articles for inclusion, collected data using a standardized data collection tool, and assessed study risk of bias.</p><p><strong>Results: </strong>Forty-four articles met our inclusion criteria; 31 were case reports/series reporting 84 cases and 13 were single-arm observational studies reporting a total of 576 cases. These studies were added to the literature from our original systematic review, totaling 59 studies and 682 patients. Sublingual buprenorphine was the most common initial formulation, comprising 55% (376/682) of cases. In case reports/series, use of a validated scale to measure withdrawal was uncommon; validated scales were only used in 36% of patients. All other patients had withdrawal assessed in a manner not utilizing a validated scale. Approximately half of these patients experienced any level of withdrawal (57/106 = 54%). The specific outcome of \"any level of withdrawal\" was not consistently reported in single-arm observational studies. Eight studies reported on any level of withdrawal, which occurred in 41% (177/428) of initiation attempts; some patients experienced more than one initiation attempt. Thirteen patients in case reports/series and 37 patients in the single-arm observational studies reported clinically significant withdrawal (50/682 = 7%). 81% (451/555) of patients transitioned to buprenorphine.</p><p><strong>Conclusion: </strong>The prevalence of buprenorphine dosing strategies that aim to omit POW has vastly increased over the past 4 years. While quality of evidence remains low, the increased quantity of publications and integration into health-system guidelines and protocols demonstrates the need for prospective, controlled studies. It is unknown how selection bias impacts current findings, further highlighting the need for prospective, randomized, controlled trials evaluating these dosing strategies.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"19"},"PeriodicalIF":3.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"We need all hands on deck\": characterizing addiction medicine training in Canada-a mixed methods study of fellowship program directors.","authors":"Clara Lu, Kathryn Chan, Leslie Martin, Nadia Fairbairn","doi":"10.1186/s13722-025-00543-4","DOIUrl":"10.1186/s13722-025-00543-4","url":null,"abstract":"<p><strong>Background: </strong>Addiction Medicine training in Canada has evolved substantially in the last few years with the establishment of accreditation standards and several new fellowship programs. The novelty of these formal training programs, created in response to complex and ever-expanding clinical needs in Addiction Medicine, creates unique educational circumstances that must be understood to support future growth. This study characterizes the current state of these postgraduate training programs in Canada through the perspectives of Program Directors (PDs).</p><p><strong>Methods: </strong>This study is a mixed methods study of 12 PDs. In Phase 1, participants completed a quantitative survey analyzed through descriptive statistics. In Phase 2, participants underwent a qualitative semi-structured interview that was coded with a thematic analysis approach. Mixing occurred both during the interim analysis between phases and during the interpretation stage.</p><p><strong>Results: </strong>28 trainees enrolled in a fellowship program in 2021-22 across 10 programs, and 27 trainees enrolled in 2022-23 across 11 programs. In each year, there were significantly fewer available spots than applications (31% and 29%, respectively). PDs identified a funding \"bottleneck\" as the most difficult and important challenge facing programs, with trainees supported by diverse and unstable funding sources. Qualitative analysis highlighted the need for sustainable funding models, flexibility toward alternative training pathways (shorter durations of training and re-entry from practice), and establishment of a national community of practice to support the co-creation of a robust addictions medical education infrastructure.</p><p><strong>Conclusion: </strong>For Addiction Medicine training to meet workforce demands, PDs stressed that funding was the challenge of prime importance. Future studies should examine the perspectives of Addiction Medicine fellows, the clinical and research impacts of fellowship graduates, and the cost-effectiveness of fellowship funding models.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"18"},"PeriodicalIF":3.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient characteristics associated with their level of twelve-step attendance prior to entry into treatment for substance use disorders.","authors":"Marc Galanter, William L White, Michael L Dennis, Brooke Hunter, Lora Passetti, Dan Lustig","doi":"10.1186/s13722-025-00542-5","DOIUrl":"10.1186/s13722-025-00542-5","url":null,"abstract":"<p><strong>Background: </strong>The availability of the fellowships of Alcoholics Anonymous and Narcotics Anonymous in community settings is extensive and patients admitted to treatment programs for substance use disorder may therefore have previously attended meetings of these two Twelve Step (TS) programs. Data on such prior attendance and related clinical findings, however, are not typically available. They can, however, be relevant to how ensuing treatment is planned. We therefore undertook this study to ascertain the feasibility of evaluating how the level of TS attendance prior to treatment entry can be evaluated, and to determine clinically relevant findings that are associated with such attendance.</p><p><strong>Methods: </strong>Over the course of 2022, 3,125 patients were admitted to a large urban multimodal United States-based treatment center. All patients were administered the structured interview-based Global Appraisal of Individual Needs upon admission. This instrument is employed to evaluate substance use, demographics, and related psychosocial variables. Clinically related variables were analyzed relative to whether given respondents have a history of any TS group attendance prior to admission.</p><p><strong>Results: </strong>Distinctions were found between the 57.3% of respondents who had previously attended any TS meetings and the 42.6% who had not attended any meetings. Compared to respondents who had never attended TS meetings, those who had ever attended scored higher on emotional problems (p <.001, d = -0.58), and had more likely undergone previous SUD treatment (p <.001, d = 0.80). They were less likely to use substances in unsafe situations (p <.001, d = -0.55) and were less likely to express reluctance to remain abstinent (p <.001, d = -0.50). The 11% of respondents who considered themselves regular TS members reported a lower frequency of recent substance use (p <.001, d = -0.80) and were more likely to have attended intensive outpatient (p <.001, 0.46) and residential (p <.001, 0.44) treatment than patients who did not consider themselves regular attenders.</p><p><strong>Conclusions: </strong>Examination of TS attendance prior to treatment admission is feasible. Findings can be clinically relevant for differential treatment planning and can also serve as a basis for further research into the role of TS participation in community settings.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"16"},"PeriodicalIF":3.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual differences in treatment effects of internet-based cognitive behavioral therapy in primary care: a moderation analysis of a randomized clinical trial.","authors":"Karin Hyland, Danilo Romero, Sven Andreasson, Anders Hammarberg, Erik Hedman-Lagerlöf, Magnus Johansson","doi":"10.1186/s13722-025-00546-1","DOIUrl":"10.1186/s13722-025-00546-1","url":null,"abstract":"<p><strong>Background and aims: </strong>Little is known regarding predictors of outcome in treatment of alcohol dependence via the internet and in primary care. The aim of the present study was to investigate the role of socio-demographic and clinical factors for outcomes in internet-based cognitive behavioral treatment (ICBT) added to treatment as usual (TAU) for alcohol dependence in primary care.</p><p><strong>Design: </strong>Secondary analyses based on data from a randomized controlled trial in which participants were randomized to ICBT + TAU or to TAU only.</p><p><strong>Setting: </strong>The study was conducted in collaboration with 14 primary care centers in Stockholm, Sweden.</p><p><strong>Participants: </strong>The randomized trial included 264 adult primary care patients with alcohol dependence enrolled between September 2017 and November 2019.</p><p><strong>Interventions: </strong>Patients in the parent trial were randomized to ICBT that was added to TAU (n = 132) or to TAU only (n = 132). ICBT was a 12-week intervention based on motivational interviewing, relapse prevention and behavioral self-control training.</p><p><strong>Measures: </strong>Primary outcome was number of standard drinks last 30 days. Sociodemographic and clinical predictors were tested in separate models using linear mixed effects models.</p><p><strong>Findings: </strong>Severity of dependence, assessed by ICD-10 criteria for alcohol dependence, was the only predictor for changes in alcohol consumption and the only moderator of the effect of treatment. Participants with severe dependence showed a larger reduction in alcohol consumption between baseline and 3-months follow-up compared to participants with moderate dependence. The patients with moderate dependence continued to reduce their alcohol consumption between 3- and 12-months follow-up, while patients with severe dependence did not.</p><p><strong>Conclusions: </strong>Dependence severity predicted changes in alcohol consumption following treatment of alcohol dependence in primary care, with or without added ICBT. Dependence severity was also found to moderate the effect of treatment. The results suggest that treatment for both moderate and severe alcohol dependence is viable in primary care.</p><p><strong>Clinical trial registration: </strong>The study was approved by the Regional Ethics Board in Stockholm, no. 2016/1367-31/2. The study protocol was published in Trials 30 December 2019. The trial identifier is ISRCTN69957414, available at http://www.isrctn.com , assigned 7 June 2018, retrospectively registered.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"17"},"PeriodicalIF":3.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa.","authors":"Bronwyn Myers, Kristen S Regenauer, Kim Johnson, Imani Brown, Alexandra L Rose, Nonceba Ciya, Sibabalwe Ndamase, Yuche Jacobs, Morgan S Anvari, Abigail Hines, Dwayne Dean, Rithika Baskar, Jessica F Magidson","doi":"10.1186/s13722-025-00544-3","DOIUrl":"10.1186/s13722-025-00544-3","url":null,"abstract":"<p><strong>Introduction: </strong>In South Africa, community-oriented primary care teams work to re-engage out-of-care people with HIV (PWH) in treatment, many of whom have substance use (SU) concerns. SU stigma is high among these teams, limiting care engagement efforts. Integrating peer recovery coaches into community-oriented primary care teams could shift SU stigma and improve patients' engagement in care. The peer role does not exist in SA and represents a workforce innovation. To enhance acceptability, feasibility, and appropriateness for the local context, we engaged multiple stakeholder groups to co-design a peer role for community-oriented primary care team integration.</p><p><strong>Methods: </strong>We used a five-step human-centered design process: (i) semi-structured interviews with healthcare worker (n = 25) and patient (n = 15) stakeholders to identify priorities for the role; (ii) development of an initial role overview; (iii) six ideation workshops with healthcare worker (n = 12) and patient (n = 12) stakeholders to adapt this overview; (iv) refinement of the role prototype via four co-design workshops with healthcare worker (n = 7) and patient (n = 9) stakeholders; and (v) consultation with HIV and SU service leaders to assess the acceptability and feasibility of integrating this prototype into community-oriented primary care teams.</p><p><strong>Results: </strong>Although all stakeholders viewed the peer role as acceptable, patients and healthcare worker identified different priorities. Patients prioritized the care experience through sharing of lived experience and confidential SU support. Healthcare worker prioritized clarification of the peer role, working conditions, and processes to limit any impact on the community-oriented primary care team. A personal history of SU, minimum 1 year in SU recovery, and strong community knowledge were considered role prerequisites by all stakeholders. Through the iterative process, stakeholders clarified their preferences for peer session structure, location, and content and expanded proposed components of peer training to include therapeutic and professional work practice competencies. Service leaders endorsed the prototype after the addition of peer integration training for community-oriented primary care teams and peer mentoring to address community and team dynamics.</p><p><strong>Conclusion: </strong>Stakeholder engagement in an iterative design process has been integral to co-designing a peer role that multiple stakeholder groups consider acceptable and that community-oriented primary care teams are willing to implement. This offers a methodological framework for other teams designing SU workforce innovations.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"15"},"PeriodicalIF":3.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early findings on home delivery of buprenorphine and retention in treatment for opioid use disorder.","authors":"Marlene C Lira, Lauren E Hendy, Alisha Liakas, Laura Turanchik, Clare Pritchard, Cynthia Jimes, M Justin Coffey","doi":"10.1186/s13722-025-00545-2","DOIUrl":"10.1186/s13722-025-00545-2","url":null,"abstract":"<p><p>Individuals with opioid use disorder face barriers accessing first-line pharmacotherapy. Home delivery interventions have been shown to improve medication adherence for other chronic diseases, but the relationship between buprenorphine home delivery and opioid use disorder treatment outcomes has not been assessed. We evaluated the association between medication home delivery and retention in treatment in a feasibility study of adults who initiated telemedicine treatment for opioid use disorder and received one or more prescriptions. We described the characteristics of patients and estimated the odds of attending a telemedicine visit three and six months after enrollment as a function of home delivery use using logistic regression. The sample consisted of 337 adults with the following characteristics: mean age 40.8 years (SD 10.1), 51.0% male, and 70.9% commercially insured. In the first 30 days of treatment 6.8% (n = 23) of patients used home delivery. At three months, the percentages of individuals retained among those with and without home delivery were 82.6% and 58.9%, respectively (odds ratio [OR]: 3.31, 95% confidence interval [CI]: 1.10-9.96). At six months, the percentages of individuals retained among those with and without home delivery were 78.6% and 45.5%, respectively (OR: 4.39, 95% CI: 1.19-16.25, n = 203). Although uptake of medication delivery through the pharmacy partner was low within this sample of patients receiving treatment for opioid use disorder, its use was associated with increased retention in care at three and six months. Given the small sample size, low uptake, and limited statistical power, additional research is warranted.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"14"},"PeriodicalIF":3.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of heroin and fentanyl use in US nationally representative surveys.","authors":"Jarratt D Pytell, Paul J Christine, Katherine LeMasters, Karilynn M Rockhill, Joshua C Black, Richard C Dart, Ingrid A Binswanger","doi":"10.1186/s13722-025-00539-0","DOIUrl":"10.1186/s13722-025-00539-0","url":null,"abstract":"<p><strong>Background: </strong>Given the opioid overdose crisis, surveillance of evolving opioid use patterns is critical to the effective deployment of mitigation strategies. The National Survey on Drug Use and Health (NSDUH) provided the first annual US estimate of illicitly manufactured fentanyl (IMF) use in 2022. However, as a household survey, NSDUH may not capture the full extent of population heroin and IMF use. We compare estimates of past-year heroin and IMF use and correlates of use in NSDUH and the Survey of Non-Medical Use of Prescription Drugs (NMURx) survey which employ an alternate sampling strategy.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of the 2022 NSDUH and NMURx. NSDUH samples respondents using a probability-based approach targeting community-dwelling individuals, while NMURx samples respondents using an opt-in, online survey panel. US adults ages 18 years and older were included. The main outcomes were differences in the weighted percentage of population reporting past-year use of heroin, IMF, and either heroin or IMF between the surveys. Secondary outcomes were the patterns of association of past-year heroin or IMF use with comorbid substance use, treatment utilization, and demographic characteristics between the surveys. Data were analyzed March to June 2024.</p><p><strong>Results: </strong>NSDUH (n = 47,100 respondents) had a lower proportion of respondents who identified as non-Hispanic White and graduated college, and a higher proportion with past week employment than NMURx (N = 59,041 respondents). Past-year use of heroin, IMF, and either heroin or IMF were lower in the NSDUH than the NMURx. NSDUH estimated 0.52% (95% CI: 0.40%, 0.69%) %) of the US population used either heroin or IMF in the past year compared to 1.05% (95% CI: 0.97%, 1.14 0) in NMURx. In regression models, stimulant and benzodiazepine use were consistently associated with increased heroin or IMF use across both surveys.</p><p><strong>Conclusions and relevance: </strong>The estimated prevalence of heroin or IMF use was nearly 50% higher in the NMURx compared to NSDUH. These results highlight the importance of using complementary surveillance approaches to obtain accurate estimates of the prevalence and patterns of heroin or IMF use.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"13"},"PeriodicalIF":3.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study of twice-weekly group-based written exposure therapy for veterans in residential substance use treatment: effects on PTSD and depressive symptoms.","authors":"Natalia Van Doren, Fang-Hsi Chang, Amanda Nguyen, Kevin R McKenna, Derek D Satre, Shannon Wiltsey-Stirman","doi":"10.1186/s13722-024-00531-0","DOIUrl":"10.1186/s13722-024-00531-0","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic stress disorder (PTSD) is highly comorbid with substance use disorders (SUDs), resulting in high prevalence of PTSD among individuals in residential SUD care. However, there is limited research on integrating trauma treatment into residential SUD care settings. The aim of the present project was to conduct an initial evaluation of the effects of group-based Written Exposure Therapy (WET) on PTSD and depressive symptoms that was integrated into programming for individuals in residential SUD treatment.</p><p><strong>Methods: </strong>Participants were 48 Veterans with comorbid PTSD-SUD from a 28 day residential SUD program at a Veterans Affairs Medical Center. Eligible participants were enrolled in 5 sessions of WET, delivered twice-weekly in an adapted group format. PTSD symptoms and depressive symptoms were assessed at each session with the Posttraumatic Stress Disorder Checklist, DSM-5 version (PCL-5) and the Patient Health Questionnaire (PHQ-9).</p><p><strong>Results: </strong>Over 5 months, 76.2% of the target population were successfully enrolled. Of the enrolled sample, 48 participants, 92% (n = 44) completed 3 sessions, while 56% (n = 28) completed 5 sessions. Generalized Estimating Equations (GEE) showed significant within-person reductions in PTSD symptoms over time, with an average decrease of 3.18 per session (χ² = 23.21, p = .006) and moderate effect sizes (d = 0.46 and d = 0.51 at mid- and post-treatment). In addition, there were significant reductions in depressive symptoms within-persons over time, with an average per-session reduction of 1.13 (χ² = 23.10, p = .006).</p><p><strong>Conclusion: </strong>Findings demonstrate that brief, group-delivered WET is feasible and shows promise for addressing PTSD and depressive symptoms in residential SUD treatment. Results of the present evaluation could inform further efficacy testing and implementation of PTSD treatment into residential SUD settings.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"11"},"PeriodicalIF":3.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study.","authors":"Kim Hoffman, Gillian Leichtling, Sarah Shin, Andrew Seaman, Tonhi Gailey, Hunter C Spencer, P Todd Korthuis","doi":"10.1186/s13722-025-00541-6","DOIUrl":"10.1186/s13722-025-00541-6","url":null,"abstract":"<p><strong>Background: </strong>The increase in opioid use disorder among young, nonurban people has fueled sharp rises in hepatitis C virus (HCV) infections. Innovative treatment models are needed that circumvent healthcare system barriers for people who use drugs (PWUD), particularly in rural areas. The Oregon HOPE TeleHCV study randomized PWUD living with HCV in rural Oregon to peer-facilitated and streamlined telemedicine HCV treatment (Peer TeleHCV) versus enhanced usual care (EUC) and assessed sustained virologic response at 12 weeks post treatment (SVR12). Peer Support Specialists (peers) conducted HCV screening in the community, facilitated pretreatment evaluation and linkage to telemedicine HCV treatment clinicians, and supported Peer TeleHCV study participants in HCV medication adherence. A qualitative investigation queried telemedicine clinicians and peers about their experiences with the implementation of the model and key drivers of implementation effectiveness.</p><p><strong>Methods: </strong>Two remote audio/video recorded focus groups were conducted, one with the study's clinicians and one with the peers. Participants were asked their views of key elements for successful implementation and outcomes of the Peer TeleHCV model. Group interviews lasted one hour. Recordings were professionally transcribed for thematic analysis with a mixed deductive and inductive framework, using Atlas.ti. Patients were surveyed about their interactions and satisfaction with peers.</p><p><strong>Results: </strong>Quantitative data (n = 78) indicated patients had high levels of satisfaction with and support from the peers. Three themes were identified from the qualitative data (n = 12) including. (1) Key peer-level elements such as providing support during potentially difficult lab draws, creating a peer-facilitated \"bubble of trust\" between patients and clinicians, enabling technology access, conducting outreach to maintain contact and support treatment retention, and facilitating stabilizing wrap-around services (e.g., housing vouchers) (2) Key clinician-level factors such as capacity for unscheduled peer-facilitated appointments, having dedicated time for case consults with peers, and clinicians trained in working with PWUD and skilled in identifying related clinical concerns (3) Key systems-level elements such as standing lab orders, challenges related to specialty pharmacies and Medicaid managed care organizations, and streamlined communication strategies between peers and clinicians.</p><p><strong>Conclusion: </strong>All participants reported that the Peer TeleHCV model built trust and eased barriers for PWUD initiating and remaining in HCV treatment. This low-barrier model makes space for PWUD to receive HCV treatment, regardless of drug use. Implementing support from peer specialists, telemedicine technology, and streamlined testing and treatment strategies may connect more rural PWUD living with HCV with the cure.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"10"},"PeriodicalIF":3.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial.","authors":"Kara M Magane, Richard Saitz, Sarah Fielman, Marc R LaRochelle, Christopher W Shanahan, Christine A Pace, Michael LaValley, Kaley Penington, Skylar Karzhevsky, Emily Hurstak","doi":"10.1186/s13722-024-00526-x","DOIUrl":"10.1186/s13722-024-00526-x","url":null,"abstract":"<p><strong>Background: </strong>Unhealthy alcohol use, a spectrum of use inclusive of risky consumption and alcohol use disorder (AUD), is a leading cause of preventable death in the United States. Most people with unhealthy alcohol use do not receive evidence-based treatment. This four-arm factorial design randomized trial will assess whether population health management (PHM) and clinical care management (CCM) support for primary care providers (PCPs) are associated with improved AUD treatment engagement among their patients, beyond electronic health record (EHR) prompting and decision support alone.</p><p><strong>Methods: </strong>PCPs from an urban safety-net hospital-based primary care clinic are randomized to one of four groups (1) EHR best practice advisory (BPA) and clinical decision support tools for unhealthy alcohol use (BPA), (2) BPA plus population health manager support, (3) BPA plus clinical care manager support, and (4) all three. All PCPs will have access to the EHR BPA and decision support tools which provide chart-based advisories and order set navigation. PCPs assigned to receive PHM support will receive quarterly panel-level feedback on AUD treatment metrics for their patients. PCPs assigned to receive CCM support will receive CCM facilitation of AUD treatment processes including medication counseling, referrals, and support through direct patient interactions. The primary outcome will be the percent of patients engaged in AUD treatment among those with a new AUD diagnosis on a PCP's panel. Secondary outcomes include the percent of patients with a new diagnosis of AUD who (1) initiated AUD treatment, (2) were prescribed AUD medications within 90 days, and (3) numerical counts of a range of AUD health services (outpatient encounters, specialty AUD care encounters, referrals, and acute healthcare utilization) in this sample. We will assess the primary outcome and the acute healthcare utilization secondary outcomes using Medicaid claims; the remaining secondary outcomes will be assessed using EHR data.</p><p><strong>Discussion: </strong>The study will evaluate how a targeted EHR innovation alone, compared with population health and care management enhancements alone or in combination, impact engagement in AUD treatment, a national quality of care measure. Findings will advance understanding of supports needed to improve systems of care for AUD in general settings.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier/registration number (NCT number): NCT05492942.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"9"},"PeriodicalIF":3.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}