Integrating addiction medicine into rural primary care: Strategies and initial outcomes.

OBJECTIVE: This retrospective study describes the role of behavioral health in an addiction medicine program integrated in a primary care clinic, and evaluates retention, substance use, and mental health symptoms for patients in a rural underserved community. METHOD: Data were abstracted from records of patients referred for buprenorphine treatment of opioid use disorder (N = 101; 45% female, 23% Native Hawaiian or Pacific Islander, Mage = 42.5, SD = 12.75). Among patients prescribed buprenorphine (n = 61), most had comorbid substance-related diagnoses (72% with tobacco use, 75% with at least one other substance use disorder) and non-substance-related mental health diagnoses (77%), most commonly depression and anxiety. Integrated sessions with a behavioral health provider and a buprenorphine-waivered prescriber occurred weekly to monthly. Participants completed depression and anxiety questionnaires (Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7) and provided urine samples at each visit. RESULTS: Most patients (72%) were retained for at least 3 months, with early dropout associated with higher initial depression and anxiety scores. Inconsistent urine drug tests (i.e., those positive for illicit/nonprescribed substances) were significantly more common at treatment initiation (74%) than during the most recent visit (43%, p < .001), and were associated with baseline substance and other mental health factors, as well as shorter treatment duration. Generalized estimating equations models suggested time-based improvements in depression and anxiety symptoms, especially for patients retained for at least 3 months. CONCLUSIONS: Integrating wraparound addiction treatment within a rural primary care setting is feasible and associated with improved mental health and retention outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of an elective diabetes course on student pharmacists' skills and attitudes.

OBJECTIVE: To assess the impact of an elective diabetes course on student pharmacists' skills and attitudes about diabetes management. DESIGN: A 1-credit elective course on diabetes was developed that included a 1-week simulation experience during which students completed daily insulin injections, glucose checks, carbohydrate counts, and kept a daily log. ASSESSMENT: A preintervention and postintervention survey was administered to assess students' attitudes toward and confidence in performing and teaching patients various diabetes self-management skills. Students' confidence in performing and teaching diabetes self-management skills significantly improved. Students' reflective writing assignment, diabetes logbook, weekly quizzes, and group presentation were also evaluated. CONCLUSION: A diabetes elective, which included a 1-week simulation of living as a diabetic patient, was an effective teaching method to increase students' confidence in performing and teaching diabetes self-management skills.

An online elective course for undergraduate students on common prescription medications.

OBJECTIVES: To design, implement, and evaluate an online elective course on common prescription medications for undergraduate (pre- and non-health professional) students. DESIGN: An 8-module online course on common prescription medications was designed following the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) instructional design model and offered to students for 8 consecutive semesters. ASSESSMENT: Following each offering, performance data were analyzed and a course review conducted, including evaluation of entrance survey data and course evaluations. Direct analysis of data over 2 offerings and grade distribution comparisons over all 8 offerings, demonstrated consistent knowledge gains. Feedback from course evaluations and a continual increase in enrollment over the 8 semesters indicated student satisfaction with the course. CONCLUSION: Systematic design and quality assurance/improvement strategies resulted in the successful establishment of an online pharmacotherapy course for undergraduate, nonpharmacy students.

An interprofessional activity using standardized patients.

OBJECTIVES: To describe the development and implementation of an interprofessional activity using standardized patients. METHODS: In the interprofessional standardized patient experience (ISPE), pharmacy students are teamed with medical and nursing students. This team completes an assessment of a standardized patient. During this assessment, each student has time to interview the patient according to his/her own skills and patient care perspective. After the assessment is completed, the team collaborates to develop a patient care plan. Pre-experience and post-experience surveys were conducted. RESULTS: Pharmacy students' appreciation for each profession's role in patient care increased. CONCLUSIONS: Despite multiple challenges, an interprofessional activity involving multiple health professionals from multiple institutions can be successfully implemented. Feedback from pharmacy students indicated that this activity increased students' awareness and ability to work as members of the health professional team.