Journal: Annals of Family Medicine, 2023, doi: 10.1370/afm.2997
Authors: Anvita Bhardwaj, Jessica L. Sousa, Haiden A. Huskamp, Alisa B. Busch, Alene Kennedy-Hendricks, Dominic Hodgkin, Constance Horgan, & Lori Uscher-Pines
Abstract:
Purpose: Over 29 million Americans have alcohol use disorder (AUD). Though there are effective medications for AUD (MAUD) that can be prescribed within primary care, they are underutilized. We aimed to explore how primary care physicians familiar with MAUD make prescribing decisions and to identify reasons for underuse of MAUD within primary care.
Methods: We conducted semistructured interviews with 19 primary care physicians recruited from a large online database of medical professionals. Physicians had to have started a patient on MAUD within the last 6 months in an outpatient setting. Inductive and deductive thematic analysis was informed by the theory of planned behavior.
Results: Physicians endorsed that it is challenging to prescribe MAUD due to several reasons, including: (1) somewhat negative personal beliefs about medication effectiveness and likelihood of patient adherence; (2) competing demands in primary care that make MAUD a lower priority; and, (3) few positive subjective norms around prescribing. To make MAUD prescribing a smaller component of their practice, physicians reported applying various rules of thumb to select patients for MAUD. These included recommending MAUD to the patients who seemed the most motivated to reduce drinking, those with the most severe AUD, and those who were also receiving other treatments for AUD.
Conclusions: There is a challenging implementation context for MAUD due to competing demands within primary care. Future research should explore which strategies for identifying a subset of patients for MAUD are the most appropriate and most likely to improve population health and health equity.
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Journal: JAMA Network Open, 2023, doi: 10.1001/jamanetworkopen.2023.27488
Authors: Christopher M. Jones, Beth Han, Grant T. Baldwin, Emily B. Einstein, & Wilson M. Compton
Abstract:
This cross-sectional study uses data from the 2021 National Survey on Drug Use and Health to estimate the receipt of medication for opioid use disorder among US adults with past-year opioid use disorder. It was found that approximately 1 in 5 adults with past-year OUD received any MOUD. Some groups were substantially less likely to receive MOUD, in particular Black adults, women, those unemployed, and those in nonmetropolitan areas. Receipt of telehealth treatment for substance use was associated with increased likelihood of MOUD receipt. This finding underscores the growing role telehealth can play in connecting patients with OUD to care.
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Journal: Implementation Science Communications, 2023, doi: 10.1186/s43058-023-00482-8
Authors: Carla C. Garcia, Mark Bounthavong, Adam J. Gordon, Allison M. Gustavson, Marie E. Kenny, Wendy Miller, … Hildi J. Hagedorn
Abstract:
Background: The United States has been grappling with the opioid epidemic, which has resulted in over 75,000 opioid-related deaths between April 2020 and 2021. Evidence-based pharmaceutical interventions (buprenorphine, methadone, and naltrexone) are available to reduce opioid-related overdoses and deaths. However, adoption of these medications for opioid use disorder has been stifled due to individual- and system-level barriers. External facilitation is an evidence-based implementation intervention that has been used to increase access to medication for opioid use disorder (MOUD), but the implementation costs of external facilitation have not been assessed. We sought to measure the facility-level direct costs of implementing an external facilitation intervention for MOUD to provide decision makers with estimates of the resources needed to implement this evidence-based program.
Methods: We performed a cost analysis of the pre-implementation and implementation phases, including an itemization of external facilitation team and local site labor costs. We used labor estimates from the Bureau of Labor and Statistics, and sensitivity analyses were performed using labor estimates from the Veterans Health Administration (VHA) Financial Management System general ledger data.
Results: The average total costs for implementing an external facilitation intervention for MOUD per site was $18,847 (SD 6717) and ranged between $11,320 and $31,592. This translates to approximately $48 per patient with OUD. Sites with more encounters and participants with higher salaries in attendance had higher costs. This was driven mostly by the labor involved in planning and implementation activities. The average total cost of the pre-implementation and implementation activities were $1031 and $17,816 per site, respectively. In the sensitivity analysis, costs for VHA were higher than BLS estimates likely due to higher wages.
Conclusions: Implementing external facilitation to increase MOUD prescribing may be affordable depending on the payer’s budget constraints. Our study reported that there were variations in the time invested at each phase of implementation and the number and type of participants involved with implementing an external facilitation intervention. Participant composition played an important role in total implementation costs, and decision makers will need to identify the most efficient and optimal number of stakeholders to involve in their implementation plans.
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Journal: Tobacco Control, 2023, doi: 10.1136/tc-2023-057992
Authors: Elizabeth C. Hair, Jennifer M. Kreslake, Shreya Tulsiani, Tatum McKay, & Donna Vallone
Abstract:
Background: Mass media campaigns have been shown to be effective in reducing cigarette use. However, evidence is limited for whether campaigns can shift e-cigarette use among youth and young adults (YYA). To assess the impact of the truth anti-e-cigarette campaign, which focused on the effects of vaping on mental health, this study examines the relationship between campaign awareness and e-cigarette behaviour among YYA.
Methods: Data from weekly cross-sectional surveys of YYA aged 15-24 years from September 2021 to October 2022 were used for multilevel models assessing how weekly campaign awareness is related to intentions to use e-cigarettes and current e-cigarette use (past 30 days). Weekly campaign awareness was calculated by averaging individual-level awareness for each week. Control variables included individual-level campaign awareness, sociodemographics, perceived financial situation, parental smoking, sensation seeking, and mental health.
Results: Weekly campaign awareness ranged from 50% to 78%, with most weeks (77%) being within 65% and 75% of weekly campaign awareness. At weekly awareness levels between 65% and 75%, there was a significant association with lower intentions to use e-cigarettes. A dose-response relationship was observed for current use: compared with weeks with lower (<65%) awareness, weeks with awareness of 65-70% had 14% lower odds of current use, weeks with 70-75% awareness had 16% lower odds and weeks with >75% weekly awareness had 18% lower odds (p=0.018, p=0.009 and p=0.007, respectively).
Conclusions: Findings from this analysis of weekly campaign awareness demonstrate that exposure to the truth anti-e-cigarette campaign is associated with significantly lower odds of intentions to use and current use of e-cigarette among YYA.
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Journal: Neuroscience & Biobehavioral Reviews, 2023, doi: 10.1016/j.neubiorev.2023.105295
Authors: Erynn Christensen, Maja Brydevall, Lucy Albertella, Sashka K. Samarawickrama, Murat Yücel, & Rico S.C. Lee
Abstract:
It is well-established that addiction is typically associated with a distinct pattern of neurocognitive functioning with a consensus that it is typified by impaired top-down executive control and aberrant risk-reward processing. Despite a consensus that neurocognition plays an important role in characterizing and maintaining addictive disorders, there is a lack of systematic, bottom-up synthesis of quantitative evidence showing that neurocognition predicts addictive behaviors, and which neurocognitive constructs have the best predictive validity. This systematic review aimed to assess whether cognitive control and risk-reward processes as defined by the Research Domain Criteria (RDoC) predict the development and maintenance of addictive behaviors specifically, consumption, severity, and relapse. The findings from this review expose the substantial lack of evidence for neurocognition predicting addiction outcomes. However, there is evidence that suggests reward-related neurocognitive processes may be important for the detection of early risk for addiction, as well as a potentially viable target for designing novel, more effective interventions.
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