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Association of random and observed urine drug screening with long-term retention in opioid treatment programs
No full textBackground: In the US, opioid treatment providers (OTPs) have wide latitude to perform urine drug screening (UDS) and discharge clients for positive results. OTP clients have identified randomized and directly observed UDS as potentially stigmatizing, but little research has examined the association between UDS modality and retention in OTPs.
Methods: This cross-sectional study uses the 2016-2017 NDATSS wave among OTPs that administered methadone. The exposure was a 4-level variable based on whether OTPs had a high percentage (≥ 90% of clients) who experienced randomized, observed, both, or neither modality of UDS. The outcome was the proportion of clients retained in treatment 1 year or longer (long-term retention). Analyses were conducted using fractional logit regression with survey weighting and presented as percentages and 95% confidence intervals. We also present how policies for involuntary clinic discharge modify these effects.
Results: 150 OTPs were eligible with a median of 310 clients. 40 (27%) OTPs did not highly utilize either randomized or observed UDS, 22 (15%) only highly utilized observed UDS, 42 (28%) only highly utilized randomized UDS and 46 (31%) utilized both practices on ≥ 90% of clients. Adjusted estimates for long-term retention ranged from 57.7% in OTPs that conducted both randomized and observed UDS on ≥ 90% of clients and 70.4% in OTPs that did not highly utilize these practices. Involuntary discharge may moderate this relationship.
Conclusion: Findings showed an association between high utilization of randomized and observed UDS and decreased long-term retention, suggesting that UDS modality may impact long-term OTP retention.
Keywords: Methadone; Methadone policy; Person-centered treatment; Retention; Stigma; Urine drug screening
Parental substance use and home visiting programs: Implementation considerations for relationship-based treatment
No full textHome visiting programs can provide critical support to mothers in recovery from substance use disorders (SUDs) and young children prenatally exposed to substances. However, families impacted by maternal SUDs may not benefit from traditional child-focused developmental home visiting services as much as families not impacted by SUDs, suggesting the need to adjust service provision for this population. Given the need to implement tailored services within home visiting programs for families impacted by SUDs, we sought to investigate the implementation barriers and facilitators to inform future integration of a relationship-based parenting intervention developed specifically for parents with SUDs (Mothering from the Inside Out) into home visiting programs. We conducted nine interviews and five focus groups with a racially diverse sample (N = 38) of parents and providers delivering services for families affected by SUDs in the USA. Qualitative content analysis yielded three most prominent themes related to separate implementation domains and their associated barriers and facilitators: (1) engagement, (2) training, and (3) sustainability. We concluded that the home visiting setting may mitigate the logistical barriers to access for families affected by SUDs, whereas relationship-based services may mitigate the emotional barriers that parents with SUDs experience when referred to home visiting programs.
Keywords: barriers and facilitators; home visiting; implementation; parental substance use disorder; relationship-based parenting intervention
Influenza Vaccinations Among Privately and Publicly Insured Children with Asthma
No full textObjectives: Annual influenza vaccination rates for children remain well below the Healthy People 2030 target of 70%. We aimed to compare influenza vaccination rates for children with asthma by insurance type and to identify associated factors.
Methods: This cross-sectional study examined influenza vaccination rates for children with asthma by insurance type, age, year, and disease status using the Massachusetts All Payer Claims Database (2014-2018). We used multivariable logistic regression to estimate the probability of vaccination accounting for child and insurance characteristics.
Results: The sample included 310,099 child-year observations for children with asthma in 2015-2018. Fewer than half of children with asthma received influenza vaccinations; 51.2% among privately insured and 45.1% among Medicaid insured. Risk modeling reduced, but did not eliminate, this gap; privately insured children were 3.4 percentage points (pp) more likely to receive an influenza vaccination than Medicaid insured children (95% CI: 2.6pp to 4.2pp). Risk modeling also found persistent asthma was associated with more vaccinations (7.5pp higher; 95% CI: 7.0pp to 8.0pp), as was younger age. The regression-adjusted probability of influenza vaccination in a non-office setting was 3.2 pp higher in 2018 than 2015 (95% CI: 2.2p to 4.2pp), and significantly lower for children with persistent asthma and with Medicaid.
Conclusions: Despite clear recommendations for annual influenza vaccinations for children with asthma, low rates persist, particularly for children with Medicaid. Offering vaccines in non-office settings such as retail pharmacies may reduce barriers, but we did not observe increased vaccination rates in the first years after this policy change.
Keywords: Medicaid; asthma; vaccination
Clinical review: Guide to pharmacological management in pediatric obesity medicine
No full textIntroduction: Newer pharmacotherapy agents (anti-obesity medication [AOM]) are revolutionizing the management of children and adolescents with obesity. Previously, treatment based on intensive behavioral therapy involved many patient and family contact hours and yielded improvements in obesity status of 1-3 percent of the 95th percentile of the body mass index (BMI). Newer AOMs are yielding more clinically significant improvement of 5-18 percent. This review provides guidance for practitioners in the care of children and adolescents with obesity who frequently have complex medical and behavioral health care needs. Specifically, we discuss the use of newer AOMs in these complex patients.
Methods: This review details an approach to the care of the child and adolescent with obesity using AOMs. A shared decision-making process is presented in which the provider and the patient and family collaborate on care. Management of medical and behavioral components of the disease of obesity in the child are discussed.
Results: Early aggressive treatment is recommended, starting with an assessment of associated medical and behavioral complications, weight promoting medications, use of AOMs and ongoing care. Intensive behavioral therapy is foundational to treatment, but not a specific treatment. Patients and families deserve education on expected outcomes with each therapeutic option.
Conclusions: The use of new AOMs in children and adolescents has changed expected clinical outcomes in the field of pediatric obesity management. Clinically significant improvement in obesity status occurs when AOMs are used early and aggressively. Ongoing, chronic care is the model for optimizing outcomes using a shared decision-making between provider and patient/family. Depending on the experience and comfort level of the primary care practitioner, referral to an obesity medicine specialist may be appropriate, particularly when obesity related co-morbidities are present and pharmacotherapy and metabolic and bariatric surgery are considerations.
Keywords: Advanced therapies; Obesity; Pediatrics; Pharmacotherapy; Phenotype
Challenges, Barriers, and Successes of Standardized Report Templates: Results of a Society of Interventional Radiology Survey
No full textRegistry data are being increasingly used to establish treatment guidelines, set benchmarks, allocate resources, and make payment decisions. Although many registries rely on manual data entry, the Society of Interventional Radiology (SIR) is using automated data extraction for its VIRTEX registry. This process relies on participants using consistent terminology with highly structured data in physician-developed standardized reports (SR). To better understand barriers to adoption, a survey was sent to 3,178 SIR members. Responses were obtained from 451 interventional radiology practitioners (14.2%) from 92 unique academic and 151 unique private practices. Of these, 75% used structured reports and 32% used the SIR SR. The most common barriers to the use of these reports include SR length (35% of respondents), lack of awareness about the SR (31%), and lack of agreement on adoption within practices (27%). The results demonstrated insights regarding barriers in the use and/or adoption of SR and potential solutions
Evaluation of a Novel Training Program to Help Emergency Department Nurse Residents Manage Interruptions
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation/1026/thumbnail.jp
Dedicated Discharge Pick-up Area
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation/1019/thumbnail.jp
External Urinary Catheter Devices and the Risk of UTI
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation/1018/thumbnail.jp
Streamlining Nursing Documentation on D5A
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation/1017/thumbnail.jp