Organizational and Teamwork Factors of Tele-Intensive Care Units.

BACKGROUND: Use of tele-intensive care involves organizational and teamwork factors across geographic locations. This situation adds to the complexity of collaboration in providing quality patient-centered care. OBJECTIVE: To evaluate cross-agency teamwork of health care professionals caring for patients in tele-intensive care units in rural and urban regions. METHODS: A national qualitative study was conducted in 3 US geographic regions with tele-intensive care programs. Discussions and interviews were held with key participants during site visits at 3 hub sites (specialist services location) and 8 rural spoke sites (patient location). The effects of communication and culture between the hub team and the spoke team on use of the services and effectiveness of care were evaluated. RESULTS: A total of 34 participants were interviewed. Specific organizational and teamwork factors significantly affect the functionality of a tele-intensive care unit. Key operational and cultural barriers that limit the benefits of the units include unrealistic expectations about operational capabilities, lack of trust, poorly defined leadership, and a lack of communication policies. Potential solutions include education on spoke facility resources, clearly defined expectations and role reversal education, team-building activities, and feedback mechanisms to share concerns, successes, and suggestions. CONCLUSION: Proper administration and attention to important cultural and teamwork factors are essential to making tele-intensive care units effective, practical, and sustainable.

Consistency between beliefs and behavior regarding use of substances in recovery.

This paper addresses the assumption that pathways to recovery from substance abuse and dependence, and the language used to define one's relationship to substances, translate to actual beliefs and behaviors in terms of substance use. We draw on social representation theory, and use data from a large web-based study (n=9,341) whose goal was to understand how individuals in recovery define what recovery means to them. We often hear people say that they are "in recovery," and present findings now provide empirical evidence of the prevalent meanings of this ubiquitous expression. The belief that recovery is abstinence was broadly held in our sample, especially among those exposed to treatment and 12-step self-help groups and who define themselves as in recovery-and most (but not all) of such individuals are complete abstainers (no alcohol or drugs). In contrast, among the "self-changers" who did not attend treatment or self-help groups, the most common self-definition was used to have an alcohol or drug problem but don't any more, half of whom believe that recovery is abstinence while half do not, and only one-third are abstainers. Findings are of public health relevance, as it is estimated that among American adults alone, 10% report having had alcohol or drug problems but no longer do (The New York State Office of Alcoholism and Substance Abuse Services (OASAS), 2012). In line with the central concepts of social representation theory, people's pathways to recovery have a strong effect on how they define themselves and their behaviors and beliefs, but it is not universal.

Multi-source recruitment strategies for advancing addiction recovery research beyond treated samples.

BACKGROUND: The lack of established sampling frames makes reaching individuals in recovery from substance problems difficult. Although general population studies are most generalizable, the low prevalence of individuals in recovery makes this strategy costly and inefficient. Though more efficient, treatment samples are biased. AIMS: To describe multi-source recruitment for capturing participants from heterogeneous pathways to recovery; assess which sources produced the most respondents within subgroups; and compare treatment and non-treatment samples to address generalizability. RESULTS: Family/friends, Craigslist, social media and non-12-step groups produced the most respondents from hard-to-reach groups, such as racial minorities and treatment-naïve individuals. Recovery organizations yielded twice as many African-Americans and more rural dwellers, while social media yielded twice as many young people than other sources. Treatment samples had proportionally fewer females and older individuals compared to non-treated samples. CONCLUSIONS: Future research on recovery should utilize previously neglected recruiting strategies to maximize the representativeness of samples.

Elements that define recovery: the experiential perspective.

OBJECTIVE: Although recovery increasingly guides substance use disorder services and policy, definitions of recovery continue to lack specificity, thereby hindering measure development and research. The goal of this study was to move the substance use disorders field beyond broad definitions by empirically identifying the domains and specific elements of recovery as experienced by persons in recovery from diverse pathways. METHOD: An Internet-based survey was completed by 9,341 individuals (54% female) who self-identified as being in recovery, recovered, in medication-assisted recovery, or as having had a problem with alcohol or drugs (but no longer do). Respondents were recruited via extensive outreach with treatment and recovery organizations, electronic media, and self-help groups. The survey included 47 recovery elements developed through qualitative work followed by an iterative reduction process. Exploratory and confirmatory factor analyses were conducted using split-half samples, followed by sensitivity analyses for key sample groupings. RESULTS: Four recovery domains with 35 recovery elements emerged: abstinence in recovery, essentials of recovery, enriched recovery, and spirituality of recovery. The four-factor structure was robust regardless of length of recovery, 12-step or treatment exposure, and current substance use status. Four uncommon elements did not load on any factor but are presented to indicate the diversity of definitions. CONCLUSIONS: Our empirical findings offer specific items that can be used in evaluating recovery-oriented systems of care. Researchers studying recovery should include measures that extend beyond substance use and encompass elements such as those examined here--e.g., self-care, concern for others, personal growth, and developing ways of being that sustain change in substance use.