Nurse prescribing practices across the globe for medication-assisted treatment of the opioid use disorder (MOUD): a scoping review.

BACKGROUND: Despite the dramatic increase in opioid-related deaths in recent years, global access to treatment remains poor. A major barrier to people accessing Medication-assisted treatment of the opioid use disorder (MOUD) is the lack of providers who can prescribe and monitor MOUD. According to the World Drug Report, more young people are using drugs compared with previous generations and people in need of treatment cannot get it, women most of all. Nurse prescribers have the potential to enhance both access and treatment outcomes. Nurse prescribing practices do, however, vary greatly internationally. The aim of this scoping review is to explore nurse prescribing practices for MOUD globally with a view to informing equitable access and policies for people seeking MOUD. METHODS: This scoping review was informed by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-ScR). Electronic searches from 2010 to date were conducted on the following databases: PsycInfo, PubMed, Embase, and CINAHL. Only studies that met the eligibility criteria and described nurse prescribing policies and/or behaviours for MOUD were included. RESULTS: A total of 22 articles were included in the review which found several barriers and enablers to nurse prescribing of MOUD. Barriers included legislation constraints, lack of professional education and training and the presence of stigmatizing attitudes. Enablers included the presence of existing supportive services, prosocial messaging, and nurse prescriber autonomy. CONCLUSION: The safety and efficacy of nurse prescribing of MOUD is well established, and its expansion can provide a range of advantages to people who are dependent on opiates. This includes increasing access to treatment. Nurse prescribing of MOUD can increase the numbers of people in treatment from 'hard to reach' cohorts such as rural settings, or those with less financial means. It holds significant potential to reduce a wide range of harms and costs associated with high-risk opiate use. To reduce drug-related death and the global burden of harm to individuals, families, and communities, there is an urgent need to address the two key priorities of nurse prescriber legislation and education. Both of which are possible given political and educational commitment.

Evaluation of Vision Referral Program With School-Aged Children and Their Parents/Guardians.

Vision plays a key role in a child's development. Early detection and treatment of vision abnormalities decreases future complications. Follow-up vision care is a common problem. Barriers to vision care include financial cost, lack of insurance knowledge to cover costs, and disbelief of vision results. The purpose of this evidence-based pilot project was to improve the rate of follow-up vision care obtained by school-aged children. The target population was school-aged children from kindergarten to fifth grade at an elementary school within Lake County, Ohio. The vision referral program included phone calls to families to identify and overcome barriers to obtaining vision care. Barriers identified with the target population include disbelief of vision results, lack of knowledge about vision health, and financial cost. Results indicated an increase of vision care rates during the 2017-2018 academic year by 60% above baseline rates from the previous academic year.

Systematic review of medical home models to promote transitions to primary adult health care for adolescents living with autism spectrum disorder.

BACKGROUND: There is a growing number of children diagnosed and living with autism spectrum disorders (ASDs) in the United States. This increasing incidence and prevalence of ASDs require care coordination within a medical home model, which needs to continue into adulthood. AIM: This paper is an evidence review of medical home models for transitioning adolescents living with ASDs from pediatric primary healthcare practices to adult primary care practices. METHOD: Databases were reviewed and articles selected based on inclusion and exclusion criteria. RESULTS: Nine articles were reviewed and four met criteria. None of the articles addressed medical home models to transition adolescents living with ASDs into adult primary healthcare services. LINKING EVIDENCE TO ACTION: There is a need for nursing to work within an interdisciplinary framework to educate adult healthcare providers on the needs of adolescents living with ASDs and to evaluate medical home transition models for this vulnerable population.

Maternal obesity and risk of infant death based on Florida birth records for 2004.

OBJECTIVE: The purpose of this study was to assess the relationship between pre-pregnancy maternal obesity and risk of infant death. METHODS: In March 2004, maternal height and pre-pregnancy weight were added to the data collected on the Florida birth certificate. Using birth records linked to infant deaths, these data were used to assess the relationship between pre-pregnancy maternal obesity, as measured by body mass index, and infant death. RESULTS: Pre-pregnancy maternal obesity was associated with increased odds of infant death. The increased risk was found with and without adjustments for maternal race, marital status, age, education, trimester prenatal care began, first birth, and tobacco use. CONCLUSION: There is a substantial and significant association between pre-pregnancy maternal obesity and infant death.

Systematic review of health literacy in Cochrane database studies on paediatric asthma educational interventions: searching beyond rigorous design.

AIM: The purpose of this study was to evaluate if paediatric asthma educational intervention studies included in the Cochrane Collaboration database incorporated concepts of health literacy. METHODS: Inclusion criteria were established to identify review categories in the Cochrane Collaboration database specific to paediatric asthma educational interventions. Articles that met the inclusion criteria were selected from the Cochrane Collaboration database in 2010. The health literacy definition from Healthy People 2010 was used to develop a 4-point a priori rating scale to determine the extent a study reported aspects of health literacy in the development of an educational intervention for parents and/or children. RESULTS: Five Cochrane review categories met the inclusion criteria; 75 studies were rated for health literacy content regarding educational interventions with families and children living with asthma. A priori criteria were used for the rating process. While 52 (69%) studies had no information pertaining to health literacy, 23 (31%) reported an aspect of health literacy. Although all studies maintained the rigorous standards of randomized clinical trials, a model of health literacy was not reported regarding the design and implementation of interventions. CONCLUSIONS: While a more comprehensive health literacy model for the development of educational interventions with families and children may have been available after the reviewed studies were conducted, general literacy levels still could have been addressed. The findings indicate a need to incorporate health literacy in the design of client-centred educational interventions and in the selection criteria of relevant Cochrane reviews. Inclusion assures that health literacy is as important as randomization and statistical analyses in the research design of educational interventions and may even assure participation of people with literacy challenges.

Fathers' coping mechanisms related to parenting a chronically ill child: implications for advanced practice nurses.

INTRODUCTION: The presence of a father has been positively associated with outcomes in several aspects of a child's life. This descriptive study investigated coping methods used by fathers of chronically ill children, fathers' perceived severity of the child's illness, and demographic differences related to coping mechanisms. METHOD: A sample of 54 fathers of chronically ill children completed measurements of demographics, coping processes, and severity levels of their child's chronic condition. Data were analyzed with SPSS 14.0 using parametric and nonparametric tests to examine relationships and coping behaviors used by fathers in northwest Florida. RESULTS: A majority of fathers used an emotion-focused coping process with a religious dimension. No association was found between perceived level of severity of their child's illness and eight subscales used to measure coping methods; however, statistical significance was found between the age and marital status of fathers with seven of the subscales. Married and older fathers more often used "positive" coping mechanisms than did younger, unmarried fathers. DISCUSSION: The findings emphasize the need for practitioners, clinicians, and educators to assess, support, and provide appropriate resources to fathers in order to promote positive effective coping and increase the level of involvement in the child's life.

State variation in underinsurance among children with special health care needs in the United States.

OBJECTIVE: National attention has focused on providing health insurance coverage for children. Less awareness has been given to underinsurance, particularly for children with special health care needs (CSHCN). Defined as having inadequate benefits, underinsurance may be a particular problem for CSHCN because of their greater needs for medical care. METHODS: We used the 2005-2006 National Survey of Children With Special Health Care Needs, a nationally representative study of >40,000 CSHCN, to address state variations in underinsurance. CSHCN with health insurance were considered underinsured when a parent reported that the child's insurance did not usually or always cover needed services and providers or reasonably cover costs. We calculated the unadjusted prevalence of underinsurance for each state. Using logistic regression, we estimated state-specific odds and prevalence for underinsurance after adjusting for poverty level, race/ethnicity, gender, family structure, language use, insurance type, and severity of child's health condition. We also conducted multilevel analyses incorporating state-level contextual data on Medicaid and the State Children's Health Insurance Program. RESULTS: Bivariate and multivariate analyses indicated that CSHCN's state of residence had a strong association with insurance adequacy. State-level unadjusted underinsurance rates ranged from 24% (Hawaii) to 38% (Illinois). After multivariate adjustments, the range was largely unchanged: 23% (Hawaii) to 38% (New Jersey). Multilevel analyses indicated that Medicaid income eligibility levels were inversely associated with the odds of being underinsured. CONCLUSIONS: The individual-level and macro-level factors examined only partly explain state variations in underinsurance. Furthermore, the macro-level factors explained only a small portion of the variance; however, other macro-level factors may be relevant for the observed patterns.

Existing population-based health databases: useful resources for nursing research.

Important research questions, such as the prevalence of health conditions in specific groups and health disparities, can be addressed through population-based health databases. Government-funded, federal databases can provide nurse researchers with a representative sample for various levels of analyses. Population-based health databases easily accessed from federal government Web sites for analysis are identified and discussed. These databases, such as the National Health Interview Survey and the National Sample Survey of Registered Nurses, were collected through rigorous probability sampling and data collection methods and can be generalized to the population of the study. The benefits and limitations of analyzing the databases as a research approach are summarized, using examples from the recently released National Survey of Children's Health. Findings from population-based studies provide significant information on health-related indicators and contribute to the development of sound recommendations for health care practice and policy, thereby supporting evidence-based practice. Analyses of population-based databases provide additional opportunities for nurse researchers to contribute to health policy and evidence-based practice within a framework of nursing-health services research.

Factors associated with not having a personal health care provider for children in Florida.

OBJECTIVE: National recommendations by the American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners promote that all children obtain quality primary care through a consistent medical provider who can better assess, diagnose, and monitor a child's health. The purpose of this article was to identify characteristics of children in Florida without a personal health care provider. METHODS: Florida data (N = 2116) from the 2003 National Survey of Children's Health were analyzed by using bivariate and multivariate methods. The dependent, or outcome, variable was a personal health care provider, defined in the National Survey of Children's Health as a personal doctor or nurse. RESULTS: In Florida, 20.1% of children (0-17 years of age) do not have a personal health care provider compared with 16.7% in the United States. Children at greatest risk are those without health insurance. Other significant risk factors include family poverty up to 100% of federal poverty level, poverty level 100% to 199%, poverty level unknown, poverty level 200% to 399%, children aged 5 to 12 years, children aged 13 to 17 years, and Hispanic ethnicity. All the factors in the Florida model were also significant in the national model. CONCLUSIONS: Lack of a personal health care provider is driven by larger community issues of health insurance, socioeconomic status, and ethnicity, including race, on a national level. To achieve the goal of a personal health care provider for children, a multifaceted approach needs to be considered. Knowing which children are without a personal health care provider provides valuable information for state policy-makers, program planners, and evaluators.

An HIV prevalence-based model for estimating urban risk populations of injection drug users and men who have sex with men.

Issues of cost and complexity have limited the study of the population sizes of men who have sex with men (MSM) and injection drug users (IDUs), two groups at clearly increased risk for human immunodeficiency virus (HIV) and other acute and chronic diseases. We developed a prototypical, easily applied estimation model for these populations and applied it to Miami, Florida. This model combined HIV prevalence estimates, HIV seroprevalence rates, and census data to make plausible estimates of the number and proportion of MSM and IDUs under a number of assumptions. Sensitivity analyses were conducted to test the robustness of the model. The model suggests that approximately 9.5% (plausible range 7.7%-11.3%) of Miami males aged 18 years or older are MSM (point estimate, N = 76,500), and 1.4% (plausible range 0.9%-1.9%) of the total population aged 18 years or older are IDUs (point estimate, N = 23,700). Males may be about 2.5 times more likely than females to be IDUs. The estimates were reasonably robust to biases. The model was used to develop MSM and IDU population estimates in selected urban areas across Florida and should be replicable in other medium-to-large urban areas. Such estimates could be useful for behavioral surveillance and resource allocation, including enhanced targeting of community-based interventions for primary and secondary HIV prevention.