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1.
PLoS One ; 16(8): e0255594, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34352012

RESUMO

INTRODUCTION: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Alcoólicos/psicologia , Depressão/terapia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Intoxicação Alcoólica/psicologia , Alcoolismo/diagnóstico , Colômbia/epidemiologia , Comorbidade , Atenção à Saúde , Depressão/psicologia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , México/epidemiologia , Pessoa de Meia-Idade , Peru/epidemiologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Encaminhamento e Consulta , Detecção do Abuso de Substâncias/métodos
2.
Subst Abus ; : 1-9, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849396

RESUMO

Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motivational (role security, therapeutic commitment, self-efficacy) and organizational context (leadership, work culture, resources, monitoring, community engagement) factors that were associated with the proportion of adult patients screened with AUDIT-C by PHC providers in Colombia, Mexico and Peru. Additionally, the study investigated whether the effect of the factors interacted with implementation strategies and the country. Methods: Pen-and-paper questionnaires were completed by 386 providers at the start of their study participation (79% female, Mage = 39.5, 37.6% doctors, 15.0% nurses, 9.6% psychologists, 37.8% other professional roles). They were allocated to one of four intervention arms: control group; short training only; short training in presence of municipal support; and standard (long) training in presence of municipal support. Providers documented their screening practice during the five-month implementation period. Data were collected between April 2019 and March 2020. Results: Negative binomial regression analysis found an inverse relationship of role security with the proportion of screened patients. Self-efficacy was associated with an increase in the proportion of screened patients only amongst Mexican providers. Support from leadership (formal leader in organization) was the only significant organizational context factor, but only in non-control arms. Conclusion: Higher self-efficacy is a relevant factor in settings where screening practice is already ongoing. Leadership support can enhance effects of implementation strategies.

3.
Clin Infect Dis ; 70(10): 2199-2205, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-31631215

RESUMO

BACKGROUND: Hepatitis C virus (HCV) infection is highly prevalent among people who inject drugs (PWID). Accurate data on HCV prevalence and incidence rates among patients receiving opioid substitution treatment (OST) are needed to estimate the current and future burden of HCV infections in this high-risk population. METHODS: Baseline data from routine care were collected between October 2014 and June 2016 from randomly selected OST facilities in Germany. The primary outcome measure was the HCV status (antibody and RNA prevalence). Patients who were HCV antibody-negative at baseline were followed up after 12 months to calculate the HCV incidence rate. RESULTS: Sixty-three facilities from 14 German Federal States provided clinical data for a total of 2466 OST patients. HCV antibody and HCV RNA prevalence were 58.8% (95% confidence interval [CI], 56.8%-60.8%) and 27.3% (95% CI, 25.5%-29.2%), respectively. At baseline, a total of 528 patients (21.4%) had previously undergone antiviral treatment. Moreover, lower HCV RNA prevalence was associated with female gender, employment, younger age, and shorter duration of OST and opioid dependence. The HCV incidence rate was 2.5 cases per 100 person-years. CONCLUSIONS: The low HCV RNA prevalence and HCV incidence rates confirm that OST in Germany is an effective setting both for treating chronic HCV infections and for preventing new infections among PWID. Scaling up the provision of OST, HCV testing, and HCV treatment among OST patients are important public health strategies for reducing HCV infections in this high-risk population.


Assuntos
Antivirais , Hepatite C , Abuso de Substâncias por Via Intravenosa , Antivirais/uso terapêutico , Feminino , Alemanha/epidemiologia , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Humanos , Incidência , Tratamento de Substituição de Opiáceos , Prevalência , Estudos Prospectivos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/epidemiologia
4.
Subst Abuse Treat Prev Policy ; 14(1): 2, 2019 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-30606188

RESUMO

BACKGROUND: Knowledge of health-related quality of life (HRQOL) of patients receiving opioid substitution treatment (OST) is limited and fragmented. The present study examines the HRQOL of a large national sample of OST patients in Germany and sociodemographic and clinical correlates. METHODS: Cross-sectional data on the HRQOL of 2176 OST patients was compared with German general population norms. Patients were recruited from 63 OST practices across Germany. To identify correlates of HRQOL, as measured with the SF-12, we performed bi- and multivariate analyses with sociodemographic and clinical variables, including patient- and clinician-reported outcomes on physical and mental health. RESULTS: Patients' HRQOL was significantly poorer than in the general population, especially their mental HRQOL. Factors associated with lower physical HRQOL were older age, longer duration of opioid dependence, hepatitis C virus infection, and HIV infection. Benzodiazepine use was associated with lower mental HRQOL, and amphetamine use with higher physical HRQOL, compared to non-use of these substances. For both mental and physical HRQOL, the factor with the strongest positive association was employment and the factors with the strongest negative associations were physical and mental health symptom severity, psychiatric diagnosis, and psychopharmacological medication. CONCLUSIONS: Compared to the general population, we found substantially lower HRQOL in OST patients, especially in their mental HRQOL. OST programs can benefit from further improvement, particularly with regard to mental health services, in order to better serve their patients' needs. Clinicians may consider the use of patient-reported outcome measures to identify patients' subjective physical and psychological needs. Further research is needed to determine if employment is a cause or consequence of improved HRQOL. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02395198 , retrospectively registered 16/03/2015.


Assuntos
Nível de Saúde , Transtornos Mentais/epidemiologia , Tratamento de Substituição de Opiáceos/psicologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
5.
Addiction ; 111(5): 783-94, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26637990

RESUMO

BACKGROUND AND AIMS: Despite ambiguous evidence for the effectiveness of alcohol screening with brief interventions (BI) in emergency departments (ED), ambition for their widespread implementation continues to grow. To clarify whether such an application of BI is justifiable, we conducted a systematic review and meta-analysis on studies testing the impact of BI on alcohol consumption. METHODS: We included peer-reviewed, randomized controlled studies investigating the effects of BI on alcohol consumption in injured and/or intoxicated patients, published January 2002-September 2015. Changes from baseline in consumption quantity, intensity and number of heavy drinking episodes were assessed at 3-, 6- and 12-month follow-up, resulting in nine separate random-effects meta-analyses of standardized mean differences (SMD). Moderation effects of intervention mode, length, type of interventionist, intensity of control intervention and study quality were assessed using subgroup comparisons and meta-regression. RESULTS: We considered 33 publications (28 separate studies) including 14 456 patients. Six of nine comparisons revealed small significant effects in favour of BI, with the highest SMD at 0.19 [95% confidence interval (CI) = 0.08-0.31]. No significant moderators could be identified, and statistical heterogeneity (I(2) ) was below 40%. CONCLUSIONS: In a large meta-analysis of randomized controlled trials in emergency care settings, there was evidence for very small effects of brief interventions on alcohol consumption reductions. More intensive interventions showed no benefit over shorter approaches. Non-face-to-face interventions appear to be comparably effective, but this finding remains tentative due to the low number of non-face-to-face studies.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Psicoterapia Breve/métodos , Diagnóstico Precoce , Serviço Hospitalar de Emergência , Tratamento de Emergência/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
BMC Infect Dis ; 15: 563, 2015 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-26653754

RESUMO

BACKGROUND: Hepatitis C virus infection is highly prevalent among people who inject drugs. Opioid substitution therapy, the standard treatment for opioid dependence, provides an excellent opportunity for the treatment of hepatitis C virus infection due to the close and regular contact between patients and clinicians. However, there is little research on the impact of opioid substitution therapy on the prevalence of the hepatitis C virus at a national level. This paper describes the protocol for the Epidemiology of Hepatitis C Virus Infection among People Receiving Opioid Substitution Therapy (ECHO) study. The aim of this study is to estimate the national prevalence and incidence of hepatitis C virus infection among people receiving opioid substitution therapy in Germany and to describe factors associated with hepatitis C treatment uptake and seroconversion. METHODS/DESIGN: An observational, longitudinal, multicentre study is being conducted between 2014 and 2016 in a representative sample of approximately 2500 people receiving opioid substitution therapy from about 100 clinicians providing opioid substitution therapy in Germany. Data will be collected during routine patient care and by means of patient and clinician questionnaires at baseline and 12-month follow-up. Stratified sampling will be performed to obtain a representative sample of clinicians providing opioid substitution therapy. The strata will be constructed based on the distribution of the total sample of clinicians providing opioid substitution therapy in Germany according to German Federal State and the number of patients per clinician. DISCUSSION: Opioid substitution therapy may be an important strategy to prevent the spread of hepatitis C virus in opioid dependent populations, but its effectiveness may be diminished by our limited understanding of factors associated with treatment uptake and seroconversion. The present study will provide important information for developing strategies to address hepatitis C virus-related disease burden in people receiving opioid substitution therapy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02395198.


Assuntos
Hepatite C/epidemiologia , Adulto , Analgésicos Opioides/uso terapêutico , Feminino , Genótipo , Alemanha/epidemiologia , Hepacivirus/genética , Humanos , Estudos Longitudinais , Masculino , Tratamento de Substituição de Opiáceos , Prevalência , Abuso de Substâncias por Via Intravenosa/complicações
7.
Front Psychiatry ; 5: 131, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25339914

RESUMO

BACKGROUND: The robust evidence base for the effectiveness of alcohol screening and brief interventions (ASBIs) in primary health care (PHC) suggests that a widespread expansion of ASBI in non-medical settings could be beneficial. Social service and criminal justice settings work frequently with persons with alcohol use disorders, and workplace settings can be an appropriate setting for the implementation of alcohol prevention programs, as a considerable part of their social interactions takes place in this context. METHODS: Update of two systematic reviews on ASBI effectiveness in workplaces, social service, and criminal justice settings. Review to identify implementation barriers and facilitators and future research needs of ASBI in non-medical settings. RESULTS: We found a limited number of randomized controlled trials in non-medical settings with an equivocal evidence of effectiveness of ASBI. In terms of barriers and facilitators to implementation, the heterogeneity of non-medical settings makes it challenging to draw overarching conclusions. In the workplace, employee concerns with regard to the consequences of self-disclosure appear to be key. For social services, the complexity of certain client needs suggest that a stepped and carefully tailored approach is likely to be required. DISCUSSION: Compared to PHC, the reviewed settings are far more heterogeneous in terms of client groups, external conditions, and the focus on substance use disorders. Thus, future research should try to systematize these differences, and consider their implications for the deliverability, acceptance, and potential effectiveness of ASBI for different target groups, organizational frameworks, and professionals.

8.
J Addict Med ; 7(6): 417-21, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24189174

RESUMO

OBJECTIVES: Most epidemiological literature on the prevalence of viral hepatitis in alcohol-dependent patients is based on older data. This study aimed to provide current estimates and an assessment of risk factors. We further investigated whether the initiation of antiviral hepatitis C virus (HCV) treatment is feasible after detoxification. METHODS: We assessed serological markers for hepatitis B virus (HBV) and HCV infection and liver enzyme levels (alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase) in a sample of 463 inpatients in a tertiary care hospital, fulfilling International Classification of Diseases, Tenth Revision criteria for alcohol dependence. A subsample of 141 patients was interviewed on addiction history and risk factors for HCV acquisition. All patients with an indication for antiviral treatment were followed up. RESULTS: Compared with that in the general population, we found an elevated anti-HCV prevalence in alcohol-dependent patients (5.2%; 95% confidence interval, 3.2%-7.2%), whereas anti-Hbc immunoglobulin G prevalence (8.3%; 95% confidence interval, 5.7%-10.8%) corresponded to normal rates. Liver enzyme levels significantly differed between patients with chronic, past/remitted, or no HCV infection. On an observational level, a history of injection drug use or nonprofessional tattooing emerged as potential risk factors. In 1 of 10 patients, antiviral therapy was initiated. This 1 patient achieved the end-of-treatment response after extended rapid virological response, despite continuous alcohol consumption. CONCLUSIONS: The elevated HCV infection rates in our sample and the higher levels of fibrosis biomarkers in those with positive polymerase chain reaction corroborate previous findings and emphasize the importance of HCV screening in this population, particularly if further risk factors like injection drug use are given. Factors influencing treatment reluctance and conditions that may enhance the feasibility of antiviral treatment in alcohol-dependent patients should be subject of further research.


Assuntos
Alcoolismo , Antivirais/uso terapêutico , Hepacivirus/imunologia , Vírus da Hepatite B/imunologia , Hepatite B , Hepatite C , Adulto , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Alcoolismo/virologia , Biomarcadores/análise , Feminino , Alemanha/epidemiologia , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Hepatite B/psicologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hepatite C/psicologia , Humanos , Testes de Função Hepática/métodos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Testes Sorológicos/métodos
9.
Clin Infect Dis ; 57 Suppl 2: S97-104, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23884073

RESUMO

BACKGROUND: People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV) infection. However, PWID are considered "difficult to treat," requiring a specifically adapted treatment setting, including psychosocial support. METHODS: In this prospective, German trial, the impact of psychoeducation (PE) on retention and sustained virologic response (SVR) during HCV therapy among PWID was evaluated. We included 198 patients in opiate substitution therapy, who fulfilled indications for antiviral treatment. All patients received pegylated interferon alfa-2a and ribavirin therapy. Patients in the intervention group (n = 82) received manualized PE sessions. RESULTS: In patients with HCV genotype 1 or 4 (GT 1/4), PE was associated with increased treatment completion (76% vs 55%, P = .038), whereas PE had no such effect among GT 2/3 patients, who showed fewer dropouts and higher SVR rates. Among GT 1/4 patients, a minimum of 5 PE sessions was associated with increased SVR (71% vs 48%, P = .037). Multivariate regression analyses confirmed the impact of PE in GT 1/4 and revealed further predictors for retention and SVR, such as preexisting mental distress and adverse events. CONCLUSIONS: In patients with a higher risk of dropout due to GT 1/4 or mental distress, PE was shown to improve retention and SVR. PE is an effective supportive intervention for HCV therapy among PWID.


Assuntos
Terapia Comportamental/métodos , Hepatite C/tratamento farmacológico , Tratamento de Substituição de Opiáceos/métodos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Adolescente , Adulto , Idoso , Antivirais/administração & dosagem , Feminino , Alemanha , Humanos , Interferon-alfa/administração & dosagem , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Polietilenoglicóis/administração & dosagem , Estudos Prospectivos , Proteínas Recombinantes/administração & dosagem , Ribavirina/administração & dosagem , Resultado do Tratamento , Carga Viral , Adulto Jovem
10.
Subst Abuse Treat Prev Policy ; 8: 26, 2013 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-23875627

RESUMO

BACKGROUND: Opiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society. Due to lessened restrictive admission criteria, the number of registered OST patients in Germany has increased continuously in the recent years, whereas the number of physicians providing OST has remained constant. Previous data already indicated a deteriorating situation in the availability or quality of OST delivered and that structural barriers impede physicians in actively providing OST. The present survey among a sample of primary care physicians in Germany aimed to identify and assess potential structural barriers for the provision of health care in the context of OST. METHODS: An anonymous written questionnaire was sent out to a sample of 2,332 physicians across Germany providing OST. Physicians contacted were identified through databases of the Federal State Chambers of Physicians and/or of the Federal Associations of Statutory Health Insurance Physicians. Data obtained were analysed descriptively. RESULTS: The response rate was 25.5% and the majority of 596 physicians sampled viewed substantial problems in terms of the regulatory framework of OST care in the German context. Furthermore, financial remuneration, insufficient qualification, as well as inadequate interdisciplinary cooperation in the treatment of comorbidities of opiate substituted patients were regarded as problematic. The number of physicians providing OST in Germany is expected to substantially decrease in the near future. CONCLUSION: Despite less restrictive admission criteria for OST in Germany, the legal regulation framework for OST is still a limiting factor through raising concerns on the provider and consumer side to be unable to adhere to the strict rules. To avoid future shortages in the provision of OST care on the system level in Germany, revisions to the legal framework seem to be necessary. In regards to adequate care for drug use-related infectious diseases and psychiatric comorbidities commonly found in opiate substituted patients, efforts are required to improve professional qualifications of physicians providing OST as well as respective interdisciplinary collaboration.


Assuntos
Acesso aos Serviços de Saúde/legislação & jurisprudência , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Médicos de Atenção Primária/estatística & dados numéricos , Coleta de Dados , Alemanha , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Tratamento de Substituição de Opiáceos/economia , Tratamento de Substituição de Opiáceos/tendências , Inquéritos e Questionários
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