Managing opioid use disorder in primary care: PEER simplified guideline.

OBJECTIVE: To use the best available evidence and principles of shared, informed decision making to develop a clinical practice guideline for a simplified approach to managing opioid use disorder (OUD) in primary care. METHODS: Eleven health care and allied health professionals representing various practice settings, professions, and locations created a list of key questions relevant to the management of OUD in primary care. These questions related to the treatment setting, diagnosis, treatment, and management of comorbidities in OUD. The questions were researched by a team with expertise in evidence evaluation using a series of systematic reviews of randomized controlled trials. The Guideline Committee used the systematic reviews to create recommendations. RECOMMENDATIONS: Recommendations outline the role of primary care in treating patients with OUD, as well as pharmacologic and psychotherapy treatments and various prescribing practices (eg, urine drug testing and contracts). Specific recommendations could not be made for management of comorbidities in patients with OUD owing to limited evidence. CONCLUSION: The recommendations will help simplify the complex management of patients with OUD in primary care. They will aid clinicians and patients in making informed decisions regarding their care.

Using Maslow's hierarchy to highlight power imbalances between visiting health professional student volunteers and the host community: An applied qualitative study.

BACKGROUND: Health professional students from high-income countries increasingly participate in short-term experiences in global health (STEGH) conducted abroad. One common criticism of STEGH is the inherent power differential that exists between visiting learners and the local community. To highlight this power differential, this paper explores perceived benefits as described by volunteer and community respondents and applies Maslow's hierarchy of needs to commonly identified themes in each respondent group. METHODS: A semistructured survey was used to collect qualitative responses from both volunteers and community members located in a Dominican Republic community, that is, a hotspot for traditionally conducted STEGH. Thematic analysis identified themes of perceived benefits from both respondent groups; each group's common themes were then classified and compared within Maslow's hierarchy of needs. RESULTS: Each respondent group identified resource provision as a perceived benefit of STEGH, but volunteer respondents primarily focused on the provision of highly-skilled, complex resources while community respondents focused on basic necessities (food, water, etc.) Volunteer respondents were also the only group to also mention spiritual/religious/life experiences, personal skills development, and relationships as perceived benefits. Applying Maslow's hierarchy thus demonstrates a difference in needs: community respondents focused on benefits that address deficiency needs at the bottom of the hierarchy while volunteers focused on benefits addressing self-transcendence/actualization needs at the top of the hierarchy. CONCLUSIONS: The perceived difference in needs met by STEGH between volunteers and the host community within Maslow's hierarchy may drive an inherent power differential. Refocusing STEGH on the relationship level of the hierarchy (i.e., focusing on partnerships) might help mitigate this imbalance and empower host communities.

Prise en charge du trouble de consommation d'opioïdes en première ligne: Lignes directrices simplifiées de PEER.

OBJECTIF: Utiliser les meilleures données probantes et les meilleurs principes de prise de décision partagée et éclairée à notre disposition pour élaborer des lignes directrices de pratique clinique visant une approche simplifiée de prise en charge du trouble de consommation d'opioïdes (TCO) en première ligne. MÉTHODES: Onze professionnels de la santé et professionnels paramédicaux représentant divers milieux de pratique, professions et lieux ont créé une liste de questions pertinentes à la prise en charge du TCO en première ligne. Ces questions étaient liées au contexte thérapeutique, au diagnostic, au traitement et à la prise en charge des comorbidités dans le TCO. Les questions ont été étudiées par une équipe expérimentée dans l'évaluation des données probantes à l'aide d'une série de revues systématiques d'études randomisées et contrôlées. Les recommandations émises par le comité des lignes directrices reposent sur les revues systématiques. RECOMMANDATIONS: Les recommandations font ressortir le rôle des soins primaires dans le traitement des patients aux prises avec un TCO, de même que les traitements pharmacologiques et psychothérapies et les diverses pratiques de prescription (p. ex. test urinaire de dépistage de drogues et contrats). Aucune recommandation précise n'a pu être faite sur la prise en charge des comorbidités chez les patients aux prises avec un TCO, en raison des données probantes limitées. CONCLUSION: Les recommandations contribueront à simplifier la prise en charge des cas complexes de TCO en première ligne. Elles aideront tant les cliniciens que les patients à prendre des décisions éclairées au sujet de leurs soins.

Barriers and facilitators to office-based opioid agonist therapy prescribing and effective interventions to increase provider prescribing: protocol for a systematic review.

BACKGROUND: Opiate agonist therapy (OAT) prescribing rates by family physicians are low in the context of community-based, comprehensive primary care. Understanding the factors that support and/or inhibit OAT prescribing within primary care is needed. Our study objectives are to identify and synthesize documented barriers to, and facilitators of, primary care opioid agonist prescribing, and effective strategies to inform intervention planning and support increased primary care OAT prescribing. METHODS/DESIGN: We will systematically search EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, MEDLINE, and gray literature in three domains: primary care providers, opioid agonist therapy, and opioid abuse. We will retain and assess primary studies reporting documented participation, or self-reported willingness to participate, in OAT prescribing; and/or at least one determinant of OAT prescribing; and/or strategies to address determinants of OAT prescribing from the perspective of primary care providers in comprehensive, community-based practice settings. There will be no restrictions on study design or publication date. Studies limited to specialty clinics with specialist prescribers, lacking extractable data, or in languages other than English or French will be excluded. Two reviewers will perform abstract review and data extraction independently. We will assess the quality of included studies using the Joanna Briggs Institute Critical Appraisal Tool. We will use a framework method of analysis to deductively code barriers and facilitators and to characterize effective strategies to support prescribing using a combined, modified a priori framework comprising the Theoretical Domains Framework and the Consolidated Framework for Implementation Research. DISCUSSION: To date, no synthesis has been undertaken of the barriers and facilitators or effective interventions promoting OAT prescribing by primary care clinicians in community-based comprehensive care settings. Enacting change in physician behaviors, community-based programming, and health services is complex and best informed by using theoretical frameworks that allow the analysis of the available data to assist in designing and implementing interventions. In light of the current opioid crisis, increasing the capacity of primary care clinicians to provide OAT is an important strategy to curb morbidity and mortality from opioid use disorder. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD86835.

Sexual health knowledge in a vulnerable population: a survey of adolescents in the bateyes of La Romana, Dominican Republic.

OBJECTIVE: Undocumented Haitian migrants to the Dominican Republic often live in impoverished communities called bateyes. These contexts present challenges for adolescent sexual health education. To inform development of appropriate adolescent education programs, this study assessed their general sexual health knowledge. METHODS: A locally developed sexual health knowledge survey was administered to 930 grade 7-12 adolescents attending six batey schools. Analysis of aggregated responses reviewed general demographics (e.g. age and sex), and identified top community sexual health concerns and most trusted information sources. RESULTS: Top concerns included menstruation (25.5%), HIV (21.8%), and family planning (13.3%); stratification by sex identified discordance around menstruation (89.2% female, 10.8% male) and HIV (67.1% male, 32.9% female), but not family planning (47.2% male, 52.8% female). Parents were identified as the most trusted information source, irrespective of concern. CONCLUSION: Community concerns around menstruation matches extant developing-world literature that links menarche with female stigma and school absence. Interest in HIV and family planning suggests targeted promoted efforts would be of benefit. Trust in parents is reflective of cultural traditions and suggests potential knowledge impacts arising from effective parental education.