A pilot observational study of recreational trail riding for Veterans with addictive disorders.

OBJECTIVES: The aim of study was to assess the safety, feasibility, and preliminary outcomes of recreational trail riding for Veterans with addictive disorders. DESIGN: This was an observational pilot study. SETTING: United States Veterans Health Care Administration Medical Center. Participants were 18 Veterans, 13 males and 5 females All had at least one addictive disorder, with most common being alcohol use disorder. INTERVENTION: A recreational trail ride of approximately two hours duration. MAIN OUTCOME MEASURES: Assessment of safety and pre- and post-intervention instruments, The State-Trait Anxiety Inventory, Craving Experience Questionnaire, Positive and Negative Affect Scale and Conner-Davidson Resilience Scale were utilized to assess changes in anxiety, craving, affect, and resilience, respectively. RESULTS: The intervention was feasible to utilize for the population studied. In addition, it was possible to conduct the rides in such a way as to minimize risk to participants and there were no serious adverse outcomes to patients, staff, or equines. However, there was one incident that had potential to cause injury. There were significant pre- to post-intervention decreases in anxiety, negative affect and craving as well as increased positive affect. There was not a statistically significant increase in resilience. CONCLUSIONS: These results indicate that recreational trail riding is, at least in some settings, feasible to utilize for this population. The safety assessment indicated that this intervention can be conducted in a manner such that risk can be mitigated. However, trail riding is a dangerous activity that can result in serious injury or death to participants. Thus, such activities should only be considered by programs that have the ability to implement stringent safety protocols. Preliminary outcomes suggest that this intervention has the potential to be beneficial to for Veterans with addictive disorders. Additional, more rigorous randomized, controlled studies are warranted.

Trends in telephonic comprehensive medication review in the United States from 2000 to present: a scoping literature review.

BACKGROUND: Although comprehensive medication review (CMR) services have been shown to provide value to patients and payers, the extent of uniformity in service delivery is unknown. A variety of standards and recommendations are available from academic and professional sources, but variation in service provision is an important consideration when attempting to measure or compare service quality nationally. OBJECTIVE: This study aimed to identify and summarize trends in the peer-reviewed and gray literature describing telephonic CMR delivery and content. METHODS: A scoping review of peer-reviewed and gray literature was conducted to quantify and qualify trends in CMR service. Two independent reviewers screened abstracts from 9 bibliographic databases and selected gray literature sources in accordance with the Joanna Briggs Institute guidelines and an internally developed protocol. Inclusion criteria for the review were English language; discussion of telephonic CMR service in the United States; research, legislation, or guidelines that describe CMR content coverage requirements for payment; and publication from the year 2000 to the present. Data relating to publication type, study design, setting, region, and themes of CMR content were collated into a Microsoft Excel data extraction form. Qualitative thematic analysis was conducted, and key findings and concepts were reported contextually. RESULTS: Of 374 identified documents screened, 15 were included in this scoping review and thematic analysis. The following characteristics of CMRs were identified: content, coverage, eligibility, frequency, process, and responsiveness. All published documents (n = 15, 100%) included a discussion of CMR content, and 14 sources (93%) addressed process elements of providing a CMR. Discussion of other themes varied in frequency across documents, ranging from 3 articles (20%) addressing organizational goals for CMR to 12 articles (80%) including elements of responsiveness. Within-theme variation was also observed for several CMR content areas. CMR process was the most heterogeneous theme with topics ranging from access to patient health records to pharmacist training. CONCLUSIONS: Assessment of telephonic CMR comprised a small but steadily increasing portion of the medication therapy management literature. Publications since 2015 have shown an increasing consensus of CMR content and purpose. Per the identified literature, there is an ongoing demand for higher-quality, more holistic CMRs, but there is no consensus on how to measure CMR quality. Future work should include engaging with CMR experts to understand variability in measures of CMR success.