Multidimensional assessment of access to medications for opioid use disorder across urban and rural communities: A scoping review.

BACKGROUND: The majority of patients with opioid use disorder do not receive medications for opioid use disorder (MOUD), especially in rural areas. The patient-centered access to healthcare framework posits access as a multidimensional phenomenon impacted by five healthcare system and five patient ability dimensions. Interventions to improve local MOUD treatment outcomes require an understanding of how these dimensions differ across urban and rural communities. This scoping review sought to systematically appraise the literature on MOUD access across urban and rural communities (i.e., rurality) in the US using the patient-centered access framework. METHODS: We performed a scoping review of 1) electronic databases, 2) grey literature, and 3) correspondence with content experts (March 2021). We included articles specifying the study sample by rurality and examining at least one dimension of access to MOUD. The analysis and qualitative synthesis of study results examined study characteristics and categorized key findings by access dimensions. RESULTS: The search produced 3963 unique articles, of which 147 met inclusion criteria. Among included studies, 96% (142/147) examined healthcare system dimensions of access while less than 20% (25/147) examined any of the five dimensions of patient ability. Additionally, 49% (72/147) of studies compared access dimensions by rurality. Across studies, increasing rurality was associated with fewer available MOUD services, but little was known about geographic variation in other critical dimensions of access. CONCLUSIONS: The vast majority of studies examined healthcare system dimensions of MOUD access and few studies made comparisons by rurality or prioritized the patient's perspective, limiting our understanding of how access differs by rurality in the US. As COVID-19 spurs novel changes in MOUD delivery, this inadequate multidimensional understanding of MOUD access may impede the tailoring of interventions to local needs. There is an urgent need for mixed-methods and community-engaged research prioritizing the patient's perspective of MOUD access by rurality. REGISTRATION: Open Science Framework (https://osf.io/wk6b9/).

The cost of caring during recent epidemics: a rapid review of risk factors, psychological manifestations, and strategies for its treatment.

BACKGROUND: During epidemics, health care workers (HCWs) are particularly exposed to the risk of secondary trauma. If not effectively addressed, the consequences of such psychological distress can progress to more severe conditions. METHODS: A systematic search of several databases on the effect of SARS, MERS, and COVID-19 epidemics on the mental health of HCWs was performed according to both the Cochrane Handbook for Systematic Reviews of Interventions and the WHO Rapid Review Guide for Health Policy and Systems Research. RESULTS: The 77 reviewed studies highlighted that work organization and individual characteristics can add to mental health risk. Providing adequate training to prevent infection and prepare HCWs to handle the epidemic, strengthening team work to improve organization, and ensuring appropriate protective equipment is available can help prevent risk of psychiatric illness. CONCLUSIONS: Monitoring and addressing through tailored interventions the mental health consequences of pandemics in HCWs is necessary.

Improving community well-being through collaborative initiatives at a medical library.

BACKGROUND: In an increasingly digital age, the role of the library is changing to better serve its community. The authors' library serves health care professionals who experience high levels of stress due to everyday demands of work or study, which can have negative impacts on physical and mental health. Our library is committed to serving the needs of our community by identifying opportunities to improve their well-being. CASE PRESENTATION: Librarians at the Harvey Cushing/John Hay Whitney Medical Library at Yale University developed a group mindfulness program and a space for self-defined personal care to assist health care professionals in alleviating stress. Surveys were used to evaluate the mindfulness program and self-care space. CONCLUSIONS: We successfully implemented two collaborative wellness and self-care initiatives with students and other stakeholders, as demonstrated by program attendance, diverse space use, and positive survey responses for both initiatives. While these endeavors do not replace the need to challenge structural problems at the root of stress in the health care professions, this case report offers a blueprint for other medical libraries to support the well-being of their communities.