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01 - (link to pdf) - Olivia Randall-Kosich - Reasons for starting and stopping medications for opioid use disorder: a qualitative analysis.
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02 - (link to pdf) - Stephen Mhere - Reducing health care costs and improving health outcomes: Is patient-centered care the means to achieve the incongruent objectives?
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03 - (link to pdf) - Rachel Totaram - Participating in 12-step support groups while undergoing medication-assisted treatment for opioid use disorder: a qualitative study of individuals’ experiences with stigma
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04 - (link to pdf) - Xian-Cao - A Comparative Analysis of home and community-based long term care between the USA and China
Olivia Randall-Kosich, B.S., Barbara Andraka-Christou, J.D., Ph.D., Rachel Totaram, M.H.A., Jessica Alamo, B.A., Mayur Nadig, B.D.S.
(link to pdf)
Background: Despite their efficacy, medications for opioid use disorder (MOUD) are underutilized in the United States. Few studies have explored reasons why individuals pick MOUD versus non-MOUD options or why people discontinue using MOUD once they start. We sought to identify reasons why individuals start MOUD and stop MOUD, including how they learn of MOUD options. We also explored differences between starting and stopping the three most common formulations: methadone, oral buprenorphine, and extended-release naltrexone.
Methods: We conducted 31 semi-structured interviews over the phone with individuals with a history of MOUD utilization and one parent of an individual with a history of MOUD utilization who passed away. Participants were recruited using snowball sampling from nine U.S. states. Interviews were audio-recorded, transcribed, coded in Dedoose© software, and analyzed using thematic analysis.
Results: Participants primarily learned about buprenorphine and methadone from other individuals with OUD. Reasons for starting MOUD versus non-MOUD options varied significantly by medication and included perception of its efficacy in preventing relapse in peers (buprenorphine and methadone), exhaustion of other treatment options (methadone only), and perception of its efficacy in preventing overdose or death if relapse occurs (buprenorphine only). Across all three medications, participants stopped MOUD due to the desire to stop physical dependency (i.e. stop taking daily medication, doctor visits, etc.). Participants utilizing buprenorphine and methadone treatment felt pressure from various sources to quit their medications.
Conclusion: This study underscores the crucial role of peer-to-peer education regarding MOUD. We recommend that more peer support specialists with MOUD experience be incorporated into formal SUD treatment. Education initiatives, especially through peer-to-peer storytelling, should address misconceptions about MOUD.
Reducing health care costs and improving health outcomes: Is patient-centered care the means to achieve the incongruent objectives?
Stephen Mhere, B.S.
(link to pdf)
Purpose: This research determines if primary care physicians use patient-centered care and whether healthcare policies predicated on the practice can be effective in achieving cost reductions while improving health outcomes.
Methods: Primary care physicians were surveyed through self-administered questionnaires and a hypothesis based on proportions was developed to test their patient-centeredness. Physicians were deemed to be patient-centered if they had adopted at least five of nine attributes. Hypothesis testing was used to determine patient-centeredness. Deductive reasoning was applied to reach conclusions regarding the likely efficacy of patient-centered care (PCC) policies in reducing costs and improving health outcomes.
Results: Survey participation rate was 39.5%. Adoption rates for individual patient-centered care attributes ranged from 88.2% for electronic health record (EHR) adoption to 0.0% for patient portal implementation. Overall patient-centered care adoption rate was about 65%.
Conclusion: Primary care physicians use patient-centered care. Therefore adopting patient-centered care policies to enable reductions in healthcare spending cuts and improvements in health outcomes is unlikely to be effective. However, results show low adoption rates for some of the patient-centered attributes, providing possibilities for improvement. This study has significant internal and external validity issues, warranting further studies before concrete healthcare policies predicated on patient-centered care are adopted.
Participating in 12-step support groups while undergoing medication-assisted treatment for opioid use disorder: a qualitative study of individuals’ experiences with stigma
Rachel Totaram, M.H.A., Olivia Randall-Kosich, B.S., Brianna Alex, B.S., Barbara Andraka-Christou, J.D., Ph.D.
(link to pdf)
Purpose: To understand how stigma related to medication-assisted treatment (MAT) for opioid use disorder is operationalized in 12-step peer support groups and how individuals respond to stigma. Despite MAT’s efficacy, previous studies suggest that MAT-related stigma is common in 12-step support groups, but more information is needed about its operationalization and responses.
Methods: Individuals in OUD recovery were recruited through snow-ball sampling for phone interviews that were audio recorded and transcribed. We then created a codebook based on preliminary screening of transcripts and the research question in Dedoose software. We tested codebook reliability, adjusting codes as needed. Next, we independently coded transcripts to identify meaningful data, adding new categories in the process. We resolved discrepancies through negotiation. Finally, we analyzed coded text for themes.
Results: We recruited 35 participants from 11 states: 86% had 12-step group experience; and 88% had MAT experience. Participants frequently expressed a desire for simultaneous MAT and 12-step group participation but commonly experienced stigma. Stigma was expressed by preventing individuals in MAT from speaking at meetings, refusing to sponsor them, forbidding them from claiming “clean time,” and pressuring them MAT. Stigma differs by geographic area and specific group. Responses to stigma included hiding MAT status, “taking what you need and leaving the rest,” feeling shame or anger, and seeking new groups. Many participants want new 12-step groups formed that are explicitly open to MAT.
Conclusion: Many individuals desire simultaneous participation in MAT and 12-step groups but experience MAT-related stigma. New pro-MAT 12-step groups may be needed.
Xian Cao, B.S.
(link to pdf)
Purpose: This paper compared and contrast the home and community-based long term care between the USA and China, based on an extensive literature review.
Methods: This article described caregivers’ characteristics in the USA and China, as well as information on home and community-based service (HCBS) related policies and programs. This review also included the impact of culture on people’s perceptions and adoption of HCBS.
Results: China still lack the availability and quality of eldercare workforce and a professionalized long-term care workforce. In China, HCBS is mainly targeting on social services, which were provided through community service centers, housemaids, and homemakers. One reason may be because of filial piety culture, which values informal care for seniors than other care types. In the USA, the HCBS include both health services and human services, which is much more mature than China. However, the LTC quality and service delivery process still need further improvement to meet seniors’ need.
Conclusion: China is still in the early stage of developing comprehensive HCBS. The Chinese government needs to address the shortage of formal caregivers, providing caregiver supports and training opportunities. The USA has various HCBS program available now. However, incorporating person-centered care and culture competency skill in the HCBS is needed to improve seniors’ quality of life.
Keywords: home and community-based service, long term care, culture, Comparative Analysis