Geographic differences in buprenorphine and methadone prescribing for surgical patients with opioid use disorder

BACKGROUND: Patients with opioid use disorder (OUD) frequently present for surgery while receiving medications for OUD (MOUD), typically buprenorphine or methadone. This study evaluated MOUD use among surgical patients with OUD in a health-system spanning both urban and rural areas in Maine; a predominantly rural state with a significant opioid crisis. METHODS: We retrospectively identified adult surgical patients with OUD admitted to MaineHealth hospitals from 2014 to 2023 who were receiving MOUD prior to the day of surgery. Demographics and clinical characteristics were collected; rural designation was determined using Rural-Urban Commuting Area codes. The primary outcome was the temporal trend in proportion of surgical patients with OUD receiving methadone versus buprenorphine prior to admission. Temporal trends and geographic differences were compared using chi-square tests (p \u3c  0.05). RESULTS: Of 2099 surgical patients on MOUD, 71.4 % received buprenorphine and 28.6 % methadone. Overall, rural patients were more likely to receive buprenorphine than urban patients (75.1 % vs. 68.5 %) (p \u3c  0.001). Buprenorphine prescribing increased from 52.0 % to 84.2 % in rural areas and from 59.3 % to 72.9 % in urban areas, with corresponding declines in methadone use (both p \u3c  0.05). CONCLUSIONS: Temporal trends showed a significant shift in MOUD prescribing over the study period, with buprenorphine use increasing and methadone use declining in rural and urban populations. Although both medications are considered safe in hospitalized and surgical patients, perioperative management remains inconsistent. Further work is needed to evaluate how these prescribing trends influence clinical outcomes and ensure perioperative protocols support continuity of care for patients with OUD

Survey of MaineHealth Cancer Care Network Providers on Cannabis Use: Preparation for Studies Sponsored by the National Cancer Institute

Introduction: Cannabis and cannabinoid use in patients with cancer has rapidly scaled up over the past decade and is a topic of considerable clinical, research, and public health interest. Methods: We conducted a cannabis landscape survey among front-line providers in the MaineHealth Cancer Care Network (MHCCN) before applying and participating in National Cancer Institute (NCI)-sponsored studies on cannabis use in patients with cancer. The results of the survey can better inform participation in national studies and provide a departure point for provider educational activities focused on cannabis use in the cancer care setting. Results: Notable observations from our survey included a 58% (100/171) response rate, which signals awareness and interest in cannabis use by our provider teams. Also, 30% of providers/care team members inquire about their patients’ cannabis use, 89% agree that cannabis can be effective for managing symptoms, 54% are sensitive to stigma surrounding cannabis use (as well as 57% of their patients), only 15% considered themselves knowledgeable, and 85% are receptive to learning more about cannabis use. Discussion: These observations confirmed interest among our care teams to engage in cannabis-focused studies. They also paved a way toward participating in NCI-sponsored studies to address gaps in knowledge and the benefits and harms of cannabis and cannabinoid use in patients with cancer. Barriers and themes from the survey related to conducting research in this therapeutic area are discussed. Conclusions: Longitudinal studies evaluating the benefits and harms of cannabis use remain scarce. Significant gaps in knowledge persist for both providers and patients, compounded by regulatory, ethical, and drug provision hurdles in this research area. Our survey results offer a foundation for educating care team members about cannabis use. Alongside participation in a large, first-ever national study, we outline plans for a small pilot study that uses an innovative application to capture cannabis use and product type

CAP Faculty Development: Teaching Medical Students- Session Recording

Course Overview This is a faculty development session for the faculty of the second year TUSM Course – Competency-Based Apprenticeship in Primary Care. The session will be a 1 hour long didactic led by Marc Kimball, MD (Course Director), and will include an introduction to Adult Learning Theory and application of that theory in clinical teaching. Within the didactic, there will be some role playing to reinforce the learning objectives. Objectives Discuss the principles of Adult Learning Theory and how they relate to teaching medical students Implement the “One Minute Preceptor” tool to help with effective teaching in a clinical setting Apply the BID tool for teaching procedures/physical exam skills in a clinical settin

Perceptions of an Electronic Patient Symptom Reporting Tool by Clinicians

Prior to implementing an electronic health record-integrated patient-reported outcomes system, eSyM, the perceived facilitators and barriers to implementation from multiple stakeholder perspectives were sought. The purpose is to report the findings of the perceived facilitators and barriers to implementation of eSyM from multiple clinician stakeholder perspectives. Stakeholders included administrators, clerical staff, information technology professionals, support staff, physicians, providers, and nurses from six Symptom Management Implementation of Patient-Reported Outcomes in Oncology health systems, a diverse mix of academic/community, rural/metropolitan, and Northeastern and Southern community-based cancer centers. Site information, participant information, perceived effectiveness, and perceived patient barriers to use were collected from 173 stakeholders. RNs were the most represented participants, followed by physicians, physician assistants, and nurse practitioners. Stakeholders felt that eSyM would be effective in improving patient symptom management, keeping patients out of the hospital and emergency department, and improving clinic efficiency. Clinician stakeholders perceived eSyM as necessary and effective for improving symptom management. Most stakeholders felt that their colleagues would be supportive of using eSyM. Stakeholders perceived minor patient barriers were access to technology, distrust of technology, and English language proficiency. Computer literacy was perceived as a major barrier. Future longitudinal mixed-methods design that combines quantitative findings with qualitative observations is needed. Understanding the contextual factors that influence the facilitation or barriers of implementing eSyM is needed to scale and spread the intervention to other institutions. As a nursing intervention, the assessment of the perceptions of improvement of eSyM workflow would be especially useful

Summary of: Clinician Experiences and Comfort with Providing Harm Reduction Resources to People Who Use Drugs

Drug overdose deaths continue to rise in the United States, including in Maine, which has high rates of overdose mortality, viral hepatitis, and a recent HIV outbreak among people who use drugs. Harm reduction strategies such as naloxone distribution, safer use supplies, and linkage to syringe service programs are well established in research and improve patient safety and engagement. Despite strong evidence, clinical adoption remains inconsistent. Study found @ Clinician Experiences and Comfort with Providing Harm Reduction Resour by Amanda Cahn, Melissa Calica et al.https://knowledgeconnection.mainehealth.org/nnectr/1012/thumbnail.jp

Evaluation of 17β-Estradiol Administration by Subcutaneous Injections in Transgender Women

CONTEXT: 17β-Estradiol (E2) is increasingly administered subcutaneously (SC) to transgender women, but questions remain regarding dosing and efficacy. OBJECTIVES: The primary aims of this work were to determine if SC E2 could consistently achieve serum E2 and total testosterone (TT) levels within target therapeutic ranges and if TT and E2 levels were comparable to those achieved with standard oral therapy. The secondary aim was to determine if serum estrone (E1) and sex hormone-binding globulin (SHBG) levels were lower with SC compared to oral administration, possibly reflecting fewer first-pass hepatic effects. METHODS: This retrospective cohort study evaluated records of transgender women receiving either SC or oral E2 in the Reproductive Endocrinology and Gender Clinics at Maine Medical Center. Serum levels of E2, TT, E1, and SHBG were extracted from charts. RESULTS: Demographics were similar in SC (n = 25) and oral (n = 20) groups. Serum E2 reached the target therapeutic range (75-250 pg/mL) and TT was suppressed to less than 50 ng/mL in all patients and were not statistically different between groups. In 5 patients in the SC group, E2 was measured before and after dosing, with mean values within the target range. The median (interquartile range) E1 level was higher in the oral E2 group than in the SC E2 group (907 pg/mL [737-1576 pg/mL] and 76 pg/mL [49-96 pg/mL]; P \u3c .001). SHBG levels did not differ between groups. CONCLUSION: SC E2 administration is effective in transgender women for achieving target serum E2 and TT levels. Both SC and orally administered E2 achieved similar E2 and TT levels, but orally administered E2 resulted in much higher E1 levels

School-entry vaccine exemptions in Maine before and after public law 154, 2018-2023

Maine passed Public Law (PL) 154 in 2020, eliminating new non-medical exemptions (NMEs) to school-entry immunization requirements. We examined how this policy change affected vaccine exemption rates and clustering in kindergartens using annual, publicly available school-level counts of vaccine exemptions from the Maine Center for Disease Control and Prevention. Although NMEs decreased significantly, medical exemptions (MEs) increased and began clustering in kindergartens after PL 154\u27s implementation in 2021. This perpetuated the increased likelihood that children with exemptions, primarily MEs post-PL 154, interact with one another in school. The emergence of clusters of kindergartens with statistically significantly higher ME rates relative to the population average may create or reinforce existing under-immunized pockets at higher risk of vaccine-preventable diseases. Our results demonstrate that eliminating NMEs can substantially reduce overall school-entry vaccine exemption rates, while underscoring the need for additional guidance to support states in implementing these policy changes

Mortality Rate and Variability Associated with Pneumonia Readmission

Introduction: Pneumonia readmissions are a persistent challenge for health care providers and patients. Although the mortality risk associated with hospitalization for pneumonia is well-known, the particular risk associated with readmission for pneumonia is not as well characterized. Methods: We retrospectively examined our institution’s electronic health record to determine the 270-day mortality rate for patients readmitted after an index hospitalization for pneumonia. Results: At our institution, we found a substantial mortality risk associated with 30-day pneumonia readmissions, with variability between the 2 studied sites of care. Discussion: Various factors could contribute to high mortality associated with 30-day pneumonia readmissions. Conclusion: Additional study of the mortality rate associated with 30-day pneumonia readmissions is indicated, both locally and nationally

Staying Connected: A Longitudinal, Multisite, Interprofessional Rural Fellowship Collaboration

CONTEXT: Four interprofessional hospice and palliative medicine (HPM) fellowship programs in rural northern New England states created an in-person educational retreat series. OBJECTIVES: The goal of the series was to maximize shared educational resources and foster community amongst faculty and fellows, in an upstream attempt to improve recruitment/retention of clinicians in three rural states with inadequate access to specialty palliative care. METHODS: We organized three retreats per year starting in 2022. Each rural state hosted one retreat focused on a theme: 1) fundamental skills for HPM fellows, 2) advanced serious illness communication skills, and 3) leadership skills. Interprofessional faculty across the four programs co-taught sessions. Participating fellows and faculty were surveyed after the first two years to assess whether retreats met objectives. RESULTS: 39 fellows and faculty completed the survey (17/22 fellows and 22/41 faculty; response rate 62%). At least 88% of fellows rated the retreats effective in strengthening their clinical, communication, teamwork, and leadership skills. The majority of faculty (72%) felt the retreats had a positive impact on their teaching. Over four-fifths of faculty and fellows felt the retreats increased their sense of belonging and decreased professional isolation. The retreats were a top factor influencing fellowship choice for 29% of fellows, as well as a major incentive to remain practicing in the region for 32% of faculty. CONCLUSIONS: A series of in-person interprofessional educational retreats developed by four rural HPM fellowships strengthened fellow education, created connections among regional faculty and fellows, and were positively associated with fellow and faculty recruitment and retention

Clocking In, Burning Out: Resident Duty Hours, Health, and the Quest for Competence

CME available for 1 year after presentation CME Text Code: 103878 In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1090/thumbnail.jp