Patient experiences of buprenorphine dispensing from a mobile medical unit.

BACKGROUND: Overdose deaths continue to rise within the United States, despite effective treatments such as buprenorphine and methadone for opioid use disorder (OUD). Mobile medical units with the ability to dispense buprenorphine have been developed to engage patients and eliminate barriers to accessing OUD treatment. This study reports survey responses of patients of a mobile medical unit dispensing buprenorphine in areas of Chicago, IL with high overdose rates. METHODS: All patients who were dispensed buprenorphine via the mobile medical unit were invited to participate in a 7-item anonymous survey between May 24, 2023, and August 25, 2023. The survey included 5-point satisfaction scale, multiple-choice, and open-ended questions. Outcomes included satisfaction with buprenorphine dispensing from the mobile medical unit, satisfaction with filling buprenorphine at a pharmacy in the past, barriers experienced at pharmacies when filling buprenorphine, and whether the client would have started treatment that day if the mobile medical unit had not been present. Satisfaction scale and multiple-choice question responses were assessed using descriptive statistics. Wilcoxon signed-rank test was used to compare median satisfaction levels between receiving buprenorphine from the mobile medical unit versus filling a buprenorphine prescription at a community pharmacy. Open-ended questions were analyzed qualitatively using inductive thematic analysis. RESULTS: 106 unique patients were dispensed buprenorphine from the mobile unit during the study period. Of these patients, 54 (51%) completed the survey. Respondents reported high satisfaction with the buprenorphine dispensing process as a part of a mobile medical unit. Of those who had previously filled buprenorphine at a pharmacy, 83% reported at least one barrier, with delays in prescription dispensing from a community pharmacy, lack of transportation to/from the pharmacy, and opioid withdrawal symptoms being the most common barriers. 87% reported they would not have started buprenorphine that same day if the mobile medical unit had not been present. Nearly half of survey participants reported having taken buprenorphine that was not prescribed to them. Qualitative analysis of open-ended survey responses noted the importance of convenient accessibility, comprehensive care, and a non-judgmental environment. CONCLUSIONS: Mobile medical units that dispense buprenorphine are an innovative model to reach patients with OUD who have significant treatment access barriers. This study found that patients who experienced barriers to accessing buprenorphine from a pharmacy were highly satisfied with the mobile medical unit's buprenorphine dispensing process. Programs seeking to develop mobile buprenorphine dispensing programs should consider patient priorities of accessibility, comprehensive care, and welcoming, non-judgmental environments.

Outcomes of a mobile medical unit for low-threshold buprenorphine access targeting opioid overdose hot spots in Chicago.

INTRODUCTION: Opioid overdoses in Chicago are unevenly distributed, affecting medically underserved neighborhoods most acutely. Innovations in reaching patients perceived to be hard-to-reach (e.g., unstably housed, marginalized), especially in these underserved neighborhoods, are urgently needed to combat the overdose crisis. This study characterizes the pilot year of a mobile medical unit partnership between a large urban academic center and a community-based harm reduction organization in Chicago. METHODS: This is a retrospective cohort study of all patients who were seen on a mobile medical unit focused on providing low-threshold buprenorphine and primary care in areas with high opioid overdose rates on Chicago's West Side. Treatment episodes were accrued between July 1, 2021, and June 30, 2022 in the first year of operation. The main outcomes were number of patients seen, demographic characteristics of patients, and reason(s) for visit over time. RESULTS: The study saw 587 unique patients on the mobile medical unit between July 1, 2021, and June 30, 2022. Approximately 64.6 % were African American, and more than half lacked active insurance or could not confirm insurance status at the time of visit. The most common reason for initial visit was COVID-19 vaccination (42.4 %), and the most common reason for follow-up visit was buprenorphine treatment (51.0 %). Eleven patients initially presented for other health concerns and later returned to initiate buprenorphine. CONCLUSIONS: The mobile medical unit successfully reached nearly 600 patients in traditionally medically underserved Chicago neighborhoods with the highest overdose rates. The mobile unit's integrated approach met a variety of health needs, including buprenorphine initiation, with a unique opportunity for postoverdose initiation. Several patients initiated buprenorphine after presenting for different health concerns, showing the potential of an integrated approach to build on past mobile outreach programs and reach people with opioid use disorder who are not yet ready to initiate treatment.

Drive-thru anticoagulation clinic: Can we supersize your care today?

Warfarin therapy requires maintenance of a therapeutic international normalized ratio (INR) and thus requires routine monitoring to ensure benefits of anticoagulation, while avoiding complications. As the pharmacist's role evolves from traditional medication dispensing towards direct patient care, many anticoagulation management services are pharmacist-managed. Due to the coronavirus disease 2019 (COVID-19) pandemic, healthcare providers were faced with re-evaluating anticoagulation management practices to minimize person-to-person exposure risk. Although being anticoagulated is not considered high risk for illness from the coronavirus, these patients are often of advanced age and frequently have multiple comorbidities, putting them at increased risk. Consequently, two hospital-based, pharmacist-managed outpatient anticoagulation management services developed drive-thru curbside clinics to continue providing care to warfarin patients. The services utilized universal COVID-19 precautions to conduct curbside appointments where pharmacists determined patient's warfarin therapy plan, scheduled timely follow-up, and provided dosing instructions. With the unexpected coronavirus outbreak, this immediate change to traditional anticoagulation management was essential for safe and effective anticoagulation therapy. Implementing a curbside clinic allowed for safe distancing while managing warfarin appropriately.

Cognitive-behavioral prevention of postconcussion syndrome in at-risk patients: a pilot randomized controlled trial.

OBJECTIVE: To examine the tolerability and estimate the treatment effect of cognitive-behavioral therapy (CBT) delivered soon after mild traumatic brain injury to patients at risk for chronic postconcussion syndrome (PCS). SETTING: Tertiary rehabilitation center. PARTICIPANTS: Twenty-eight patients with uncomplicated mild traumatic brain injury, determined to be at risk for chronic PCS based on a published algorithm that incorporates subacute postconcussion symptoms and maladaptive illness beliefs (recovery expectations and perceived consequences). They were enrolled within 6 weeks postinjury. DESIGN: Open-label, parallel-group, randomized controlled trial, with masked outcome assessment 3 months after enrolment. Interventions were (1) treatment as usual (education, reassurance, and symptom management strategies) from an occupational therapist, or (2) treatment as usual plus CBT delivered by a psychologist. MAIN MEASURES: Rivermead Postconcussion Symptoms Questionnaire. RESULTS: Four participants (2:2) withdrew. Treatment credibility and satisfaction ratings were high in the CBT group. Treatment effect sizes were moderate for postconcussion symptoms (Cohen d = 0.74) and moderate-large for most secondary outcome measures (Cohen d = 0.62-1.61). Fewer participants receiving CBT had a diagnosis of PCS at follow-up (54% vs 91%, P < .05). CONCLUSION: Our preliminary data suggest that CBT delivered soon after mild traumatic brain injury is well tolerated and may facilitate recovery in patients who are at risk for chronic PCS. A definitive clinical trial is warranted.

Cumulative concussion exposure in rugby players: neurocognitive and symptomatic outcomes.

A total of 111 rugby players underwent comprehensive testing to determine the impact of self-reported concussion exposure. Reliable estimates of concussion exposure were associated with an increase in postconcussion symptoms (PCS), but not diminished neurocognitive functioning. Importantly, the effects of concussion exposure on PCS varied as a function of player status. More specifically, extent of concussion exposure was associated with increased memory complaints and overall PCS endorsements in a dose-dependent manner for retired and older recreational players, but not for those who were younger and playing at more competitive levels. Future work should systematically evaluate the constituent participant factors that may influence differential concussion outcomes.