Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 16 de 16
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Harm Reduct J ; 18(1): 119, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34823538

RESUMO

BACKGROUND: The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the USA, including for substance use disorder treatment with buprenorphine. These changes have the potential to mitigate barriers to care or to exacerbate pre-existing treatment inequities. The objective of this study was to qualitatively explore Philadelphia-based low-barrier, harm-reduction oriented, opioid use disorder (OUD) treatment provider perspectives about and experiences with telehealth during the COVID-19 pandemic, and to assess their desire to offer telehealth to patients at their programs in the future. METHODS: We interviewed 22 OUD treatment prescribers and staff working outpatient programs offering OUD treatment with buprenorphine in Philadelphia during July and August 2020. All participants worked at low-barrier treatment programs that provide buprenorphine using a harm reduction-oriented approach and without mandating counseling or other requirements as a condition of treatment. We analyzed the data using thematic content analysis. RESULTS: Our analysis yielded three themes: 1/ Easier access for some: telehealth facilitates care for many patients who have difficulty attending in-person appointments due to logistical and psychological barriers; 2/ A layered digital divide: engagement with telehealth can be seriously limited by patients' access to and comfort with technology; and 3/ Clinician control: despite some clinic staff beliefs that patients should have the freedom to choose their treatment modality, patients' access to treatment via telehealth may hinge on clinician perceptions of patient "stability" rather than patient preferences. CONCLUSIONS: Telehealth may address many access issues, however, barriers to implementation remain, including patient ability and desire to attend healthcare appointments virtually. In addition, the potential for telehealth models to extend OUD care to patients currently underserved by in-person models may partially depend on clinician comfort treating patients deemed "unstable" via this modality. The ability of telehealth to expand access to OUD care for individuals who have previously struggled to engage with in-person care will likely be limited if these patients are not given the opportunity to receive treatment via telehealth.

2.
JAMA Netw Open ; 4(7): e2118801, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34323984

RESUMO

Importance: Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. Objective: To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that racial disparities may be mitigated by giving clinicians additional information about their patients' treatment preferences and risk of opioid misuse. Design, Setting, and Participants: This study is a secondary analysis of data collected from Life STORRIED (Life Stories for Opioid Risk Reduction in the ED), a multicenter randomized clinical trial conducted between June 2017 and August 2019 in the emergency departments (EDs) of 4 academic medical centers. Participants included 1302 patients aged 18 to 70 years who presented to the ED with ureter colic or musculoskeletal back and/or neck pain. Interventions: The treatment arm was randomized to receive a patient-facing intervention (not examined in this secondary analysis) and a clinician-facing intervention that consisted of a form containing information about each patient's analgesic treatment preference and risk of opioid misuse. Main Outcomes and Measures: Concordance between patient preference for opioid-containing treatment (assessed before ED discharge) and receipt of an opioid prescription at ED discharge. Results: Among 1302 participants in the Life STORRIED clinical trial, 1012 patients had complete demographic and treatment preference data available and were included in this secondary analysis. Of those, 563 patients (55.6%) self-identified as female, with a mean (SD) age of 40.8 (14.1) years. A total of 455 patients (45.0%) identified as White, 384 patients (37.9%) identified as Black, and 173 patients (17.1%) identified as other races. After controlling for demographic characteristics and clinical features, Black patients had lower odds than White patients of receiving a prescription for opioid medication at ED discharge (odds ratio [OR], 0.42; 95% CI, 0.27-0.65). When patients who did and did not prefer opioids were considered separately, Black patients continued to have lower odds of being discharged with a prescription for opioids compared with White patients (among those who preferred opioids: OR, 0.43 [95% CI, 0.24-0.77]; among those who did not prefer opioids: OR, 0.45 [95% CI, 0.23-0.89]). These disparities were not eliminated in the treatment arm, in which clinicians were given additional data about their patients' treatment preferences and risk of opioid misuse. Conclusions and Relevance: In this secondary analysis of data from a randomized clinical trial, Black patients received different acute pain management than White patients after patient preference was accounted for. These disparities remained after clinicians were given additional patient-level data, suggesting that a lack of patient information may not be associated with opioid prescribing disparities. Trial Registration: ClinicalTrials.gov Identifier: NCT03134092.

3.
Subst Abus ; : 1-13, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34283698

RESUMO

BACKGROUND: Concurrent with the opioid overdose crisis there has been an increase in hospitalizations among people with opioid use disorder (OUD), with one in ten hospitalized medical or surgical patients having comorbid opioid-related diagnoses. We sought to conduct a systematic review of hospital-based interventions, their staffing composition, and their impact on outcomes for patients with OUD hospitalized for medical or surgical conditions. Methods: Authors searched PubMed MEDLINE, PsychINFO, and CINAHL from January 2015 through October 2020. The authors screened 463 titles and abstracts for inclusion and reviewed 96 full-text studies. Seventeen articles met inclusion criteria. Extracted were study characteristics, outcomes, and intervention components. Methodological quality was evaluated using the Methodological Quality Rating Scale. Results: Ten of the 17 included studies were controlled retrospective cohort studies, five were uncontrolled retrospective studies, one was a prospective quasi-experimental evaluation, and one was a secondary analysis of a completed randomized clinical trial. Intervention components and outcomes varied across studies. Outcomes included in-hospital initiation and post-discharge connection to medication for OUD, healthcare utilization, and discharge against medical advice. Results were mixed regarding the impact of existing interventions on outcomes. Most studies focused on linkage to medication for OUD during hospitalization and connection to post-discharge OUD care. Conclusions: Given that many individuals with OUD require hospitalization, there is a need for OUD-related interventions for this patient population. Interventions with the best evidence of efficacy facilitated connection to post-discharge OUD care and employed an Addiction Medicine Consult model.

4.
Am J Nurs ; 121(5): 11, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33872240

RESUMO

Telehealth proves to be more than just a stopgap in providing support to patients.


Assuntos
Aborto Induzido/efeitos adversos , Dismenorreia/induzido quimicamente , Mifepristona/efeitos adversos , Telemedicina/métodos , Hemorragia Uterina/induzido quimicamente , Feminino , Humanos
5.
Int J Drug Policy ; 94: 103199, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33765515

RESUMO

BACKGROUND: Access to naloxone is essential as the overdose crisis persists. We described barriers to accessing naloxone among individuals who requested and received the medication from a free mailed program and explored the relationship between how individuals with and without personal proximity to overdose learned about the program. METHODS: Secondary analysis of data from a web-based form collected 1st March 2020 to 31st January 2021. Access barriers, personal proximity to overdose (broadly defined as personally overdosing or witnessing/worrying about others overdosing), and method of learning about the program were categorized and described. RESULTS: Among 422 respondents, the most frequently reported barriers to accessing naloxone were: COVID quarantine (25.1%), lack of knowledge about access (13.2%), and cost (11.2%). Compared to those without personal proximity to overdose (38.2%), individuals with personal proximity (61.8%) heard about the program more often through an active online search (21.4% vs. 8.8%; p-value = 0.001) and less often through word of mouth (19.8% vs. 40.9%; p-value = <0.001). CONCLUSIONS: Longstanding barriers to naloxone access are compounded by the COVID-19 pandemic, making mailing programs especially salient. Differences in ways that individuals with and without personal proximity to substance use and overdose learned about this program can inform how such programs can effectively reach their target audience.


Assuntos
COVID-19 , Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Pandemias , Philadelphia , SARS-CoV-2
6.
Ethn Dis ; 31(1): 139-148, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33519164

RESUMO

Background: The United States is experiencing an opioid overdose crisis accounting for as many as 130 deaths per day. As a result, health care providers are increasingly aware that prescribed opioids can be misused and diverted. Prescription of pain medication, including opioids, can be influenced by how health care providers perceive the trustworthiness of their patients. These perceptions hinge on a multiplicity of characteristics that can include a patient's race, ethnicity, gender, age, and presenting health condition or injury. The purpose of this study was to identify how trauma care providers evaluate and plan hospital discharge pain treatment for patients who survive serious injuries. Methods: Using a semi-structured guide from November 2018 to January 2019, we interviewed 12 providers (physicians, nurse practitioners, physician assistants) who prescribe discharge pain treatment for injured patients at a trauma center in Philadelphia, PA. We used thematic analysis to interpret these data. Results: Participants identified the importance of determining "true" pain, which was the overarching theme that emerged in analysis. Subthemes included perceptions of the influence of reliable methods for pain assessment, the trustworthiness of their patient population, and the consequences of not getting it right. Conclusions: Trauma care providers described a range of factors, beyond patient-elicited pain reports, in order to interpret their patients' analgesic needs. These included consideration of both the risks of under treatment and unnecessary suffering, and overtreatment and contribution to opioid overdoses.


Assuntos
Overdose de Drogas , Alta do Paciente , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Humanos , Dor/tratamento farmacológico , Estados Unidos
7.
J Sch Nurs ; 37(1): 51-60, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33174496

RESUMO

Zero-tolerance school disciplinary policies have contributed to the proliferation of exclusionary practices, which increase the risk that minoritized students will be harmed by the school-to-prison pipeline (STPP). The purpose of this review was to explore factors that influence the STPP and highlight the role school nurses can play in protecting students from this public health crisis. We used a systematic mixed-studies review method, and 14 studies were included. Exclusionary discipline disproportionately affects minoritized students, but decreased student-teacher ratios, wellness-focused environments, and lower levels of school punishment can improve student achievement and health. The National Association of School Nurses position statement provides a framework to guide school nurses in the dismantlement of the STPP. School nurses should advocate for their position on the interdisciplinary team, funding for alternative disciplinary programs, abolition of school policing, restorative justice approaches, support for at-risk students, and anti-racism education programs for all school staff.

8.
Pain Manag Nurs ; 22(1): 11-14, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32763015

RESUMO

BACKGROUND: Opioid use disorder and overdose have reached unprecedented levels in many countries across the globe, including the United States, and pain is one of the most common reasons American adults seek healthcare. To address the interrelated public health crises of opioid use disorder and chronic pain, it is vital that clinicians practicing in diverse roles and settings possess the ability and knowledge to effectively manage pain, responsibly prescribe and monitor opioid analgesics, educate patients about harm reduction techniques, and treat opioid use disorder. However, future healthcare professionals are not receiving the training needed to competently provide this care. This gap in curriculum may lead to clinicians being unwilling and unprepared to address the current opioid and overdose crises, which requires a clinical understanding of pain and substance use disorders as well as knowledge about public health and policy interventions. To address this gap, we designed and are teaching an innovative transdisciplinary elective course titled "Opioids: From Receptors to Epidemic" for undergraduate nursing and premedical students. AIM: In this paper, we present the course curriculum in detail, with the hope that educators at other institutions will design similar courses for their health professions students.

10.
J Subst Abuse Treat ; 123: 108258, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33358617

RESUMO

The COVID-19 pandemic has led to abrupt changes in the delivery of substance use treatment, notably the adoption of telehealth services and a departure from mandatory urine drug screens (UDS). Amid current circumstances, the UDS, which had evolved to signal a "successful" recovery, no longer seems feasible, safe, or necessary. Even prior to the pandemic, the UDS had notable drawbacks, including sending a message of mistrust and hierarchy, potentially causing psychological trauma, and incentivizing falsification. Nonetheless, certain patients may state that they depend on the UDS for motivation or structure while some providers may rely on it to discover which patients are struggling. While a combination of self-report and UDS is generally regarded as the strongest measure of substance use among patients, our experiences caring for patients without the results of the UDS during the COVID-19 pandemic have forced us to examine the use of other measures to define a successful recovery. Complete abstinence may not be the goal for all patients and those who achieve abstinence may have additional goals worth supporting. While the UDS will likely be incorporated back into our treatment plans, we suggest unseating it as the centerpiece of substance use care and discovering additional methods of measuring our patients' outcomes in less traumatizing and more patient-centered ways.


Assuntos
COVID-19 , Transtornos Relacionados ao Uso de Opioides/diagnóstico , SARS-CoV-2 , Autorrelato , Detecção do Abuso de Substâncias , Urinálise , Humanos , Pandemias , Estados Unidos
11.
Artigo em Inglês | MEDLINE | ID: mdl-33057997

RESUMO

Black patients are less likely than white patients to receive pain treatment, especially opioids, for both acute and chronic pain. Black men are at higher risk than other populations of being "assumed criminal" regardless of any involvement in criminal activity. Additionally, certain injury and patient characteristics such as intentionality of injury and substance use history may lead providers to suspect criminal involvement and impact pain treatment decisions. The purpose of this study was to describe factors that predict receipt of opioid prescription at hospital discharge. We conducted a secondary analysis of data from a cohort of 623 seriously injured Black men treated at trauma centers in Philadelphia between 2013 and 2017. Regression models were used to examine relationships between discharge opioid prescriptions, injury intent, and substance use history. Controlling for age, injury severity, pain score, length of hospital stay (LOS), insurance type, and year of study, receipt of opioids was not impacted by injury intent. However, patients who self-reported substance overuse were less likely to receive opioids than those who did not. Patients with higher injury severity, pain scores, and longer LOS were more likely to receive opioids. Of patients who received opioids, patients with higher pain scores and longer LOS received higher dosages than those with lower scores and shorter LOS. While previous research highlights stigmatization experienced by intentionally injured patients, injury intent did not impact receipt of discharge opioid prescriptions in this study. Future research should continue to explore the effect of injury intent on patients' experiences in the healthcare system.

14.
J Adv Nurs ; 76(1): 34-46, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31566791

RESUMO

AIM: To explore the factors that influence provider pain treatment decision-making and the receipt of pain management by injured Black patients in the United States. DESIGN: We completed a systematic mixed studies review using a results-based convergent synthesis design. DATA SOURCES: PubMed, SCOPUS and CINAHL were searched for articles published between 2007-2017 using the search terms 'African American', 'Black American', 'race', 'pain treatment', 'pain management' and 'analgesia'. Twenty studies were included in this review. REVIEW METHOD: A search of databases and hand-searching identified peer-reviewed published papers. The Mixed Method Appraisal Tool was used to appraise the studies. RESULTS: The results indicate that healthcare provider characteristics, racial myths about pain sensitization and assumed criminality all impact provider treatment decision-making and the receipt of pain treatment by injured Black patients. IMPACT: This review addresses racial disparities in pain management by focusing on the factors that impact the receipt of pain treatment by injured Black patients. The findings will have an impact on providers who prescribe pain treatment and on the patients they treat. These findings suggest that assumed criminality of certain patients can negatively impact care, which is a type of bias not frequently explored or discussed in health disparities research. This review will help inform further research in healthcare disparities and prompt providers to examine their assumptions about the patients for whom they care. CONCLUSION: These results provide important areas for further study, including how assumed criminality of certain patients can have a negative impact on care.


Assuntos
Afro-Americanos , Disparidades em Assistência à Saúde , Manejo da Dor/métodos , Dor/etiologia , Ferimentos e Lesões/complicações , Humanos , Dor/etnologia , Padrões de Prática Médica , Ferimentos e Lesões/etnologia
15.
J Correct Health Care ; 22(2): 98-108, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26984133

RESUMO

BACKGROUND AND PURPOSE: Medication-assisted treatment (MAT) is an evidence-based method of treating opioid addiction. Of incarcerated individuals in the United States, 50% to 85% have a history of substance abuse, and > 80% of inmates with opioid addiction history do not receive treatment. The purpose of this study was to explore individuals' experiences after being tapered from MAT upon incarceration. METHODS: Interpretative phenomenological analysis was employed using in-depth interviewing of 10 participants. RESULTS: Analysis identified six themes that captured the essence of the participants' experiences. IMPLICATIONS AND CONCLUSION: Losing MAT upon incarceration was described as an extremely stressful experience for many individuals and may create issues for both inmates and facility staff. Further research is needed to discover ways to improve addiction treatment in prison.


Assuntos
Tratamento de Substituição de Opiáceos/métodos , Prisões , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Continuidade da Assistência ao Paciente , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
16.
Brachytherapy ; 6(4): 293-7, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17991626

RESUMO

Intracavitary treatment of gynecologic cancers has been the anchor of brachytherapy, and perhaps the greatest success of radiotherapy, for over a century. The woman who first performed the procedure was neither a surgeon nor radiologist, but an electrotherapeutist who began her career as an alienist. She pursued a prolific academic career despite being disabled by a disease that is no longer recognized. The fascinating life of Margaret Cleaves, the initiator of gynecologic brachytherapy, is recounted.


Assuntos
Braquiterapia/história , Neoplasias dos Genitais Femininos/história , Feminino , Neoplasias dos Genitais Femininos/radioterapia , História do Século XIX , História do Século XX , Humanos , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...