Wellness Check: Addictions
2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in addictions.
Psychosocial barriers may hinder expanded buprenorphine access amongst opioid use disorder patients
1. In this study, counselors reported that patients would be more likely to access buprenorphine treatment if they had access to greater social resources, such as housing or internet.
2. Counselors also report that increased screening at intake about psychosocial factors would be helpful.
Evidence Rating Level: 3 (Average)
One of the current national public health priorities is expanding access to treatment for people with opioid use disorder (OUD), which includes buprenorphine treatment. Though some research has been performed on improving access to initial buprenorphine treatment in the emergency department setting, it remains difficult to retain such patients for long-term care. Barriers to retention and treatment adherence are still poorly understood.
This study was a survey of addiction counselors (n=27) at the Denver Health’s Outpatient Behavioral Health Services clinic, which served approximately 900 patients at the time of study. Only counselors involved in OUD treatment were included. All clinic counselors received an invitation to complete a survey, and 25 of the 27 eligible counselors responded. There was no missing data. Counselors were asked about various patient attributes associated with difficulty engaging with treatment (for example, housing assistance, access to phone, transportation access, etc.) as well as the most helpful services for these patients.
Results showed a large majority (84%) of counselors noted that housing assistance was necessary. Additionally, factors such as residential treatment placement, mental health care, and access to a phone were deemed important to the counselors. They also noted that having a dedicated case manager for each patient would be helpful. This study did have several limitations, especially its focus on one clinic in an urban setting, which may not be generalizable. Nonetheless, this study was significant in suggesting there are many perceived barriers that may be currently impeding access to buprenorphine treatment for those with OUD.
Unhealthy alcohol use may be common amongst patients in the emergency department
1. This study found that unhealthy alcohol use was relatively common in the general emergency department patient population at Highland Hospital, Oakland, California.
2. Furthermore, those with unhealthy alcohol use also had higher rates of unstable housing, illicit drug use, prescription drug misuse.
Evidence Rating Level: 2 (Good)
Unhealthy alcohol use (UAU) is common in the United States and has cost the American health system billions of dollars in emergency department (ED) visits and hospitalizations every year. Previous research has suggested that interventions for UAU in the ED can be effective for reducing alcohol use in these patients. There is great interest in further developing these interventions. However, there is a paucity in research regarding the social context and factors influencing ED patients and AUA.
This study was a cross sectional study of ED patients at Highland Hospital, a safety-net ED located in Oakland, California, that is classified as a Level 1 Trauma Center. All patients who spoke English or Spanish and were willing to participate were included (n=2357). Patients were excluded if they were unresponsive or unstable. In the survey, patients were asked questions about alcohol habits and various social context questions, for example whether they were homeless or had unstable housing.
Results showed that amongst 758 patients who completed the survey, 296 patients (39%) screened positive for UAU. Compared to patients without UAU, patients with UAU were more likely to be homeless and have unstable housing. Patients with UAU also reported higher levels of stress, higher rates of illicit drug use, and prescription drug misuse. However, this study was limited as it focused on one safety-net ED located in an area with high rates of homelessness, which may not be generalizable to the larger population. Nonetheless, this study was significant in suggesting that UAU is common in the general ED population and may be associated with other social factors.
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1. This study found that veterans experiencing homelessness use secure messaging to their health care providers at lower rates than expected.
2. Certain groups of veterans experiencing homelessness, such as females and those with college education, were more likely to use secure messaging.
Evidence Rating Level: 2 (Good)
People who have experienced homelessness may have significant barriers to medical care, such as transportation difficulties as well as frequent changes of address and telephone numbers. Secure messaging between patients and their health care providers through patient health portals may be one way to mitigate this issue. However, it is currently unknown whether veterans who have experienced homelessness (VEHs) use these messaging systems and what barriers they may face. This is particularly relevant during the COVID-19 pandemic, which has decreased in-person office visits.
This study was a cross-sectional analysis of the 2018 Primary Care Homeless Services Tailoring survey from March to October 2018. Surveys were mailed to a stratified random sample of VEHs at 26 Veterans Affairs medical centers within the United States. Only patients who responded to the secure messaging items were included (n=5072). Patients were excluded for any missing data. Outcome variables included use of secure messaging in the My HealtheVet system and various other correlates including age, gender, race, education, and others.
The results show that only 21% of VEHs used secure messaging. Amongst those who used the platform (commonly female, had college education, 3 or more chronic medical conditions), 87% of them found the technology useful. Those who were older, black, or had substance use disorders were less likely to use the platform. However, this study was limited considering its modest response rate of 40.2%. Furthermore, patient interest in web-based telehealth was not assessed in this study. Nonetheless, this study was significant in suggesting that barriers may exist to secure messaging between patients and providers which have led to concerning disparities in healthcare.
Image: PD
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