Service Delivery in Substance Abuse Treatment: Reexamining "Comprehensive" Care

Outlines findings on organizational characteristics linked with comprehensive services -- core diagnosis and treatment and wraparound services, including transportation and childcare assistance or legal, financial, employment, or medical resources

State policy influence on the early diffusion of buprenorphine in community treatment programs

<p>Abstract</p> <p>Background</p> <p>Buprenorphine was approved for use in the treatment of opioid dependence in 2002, but its diffusion into everyday clinical practice in community-based treatment programs has been slow. This study examines the net impact of efforts by state agencies, including provision of Medicaid coverage, on program-level adoption of buprenorphine as of 2006.</p> <p>Methods</p> <p>Interviews were conducted with key informants in 49 of the 50 state agencies with oversight responsibility for addiction treatment services. Information from these interviews was integrated with organizational data from the 2006 National Survey of Substance Abuse Treatment Services. A multivariate logistic regression model was estimated to identify the effects of state efforts to promote the use of this medication, net of a host of organizational characteristics.</p> <p>Results</p> <p>The availability of Medicaid coverage for buprenorphine was a significant predictor of its adoption by treatment organizations.</p> <p>Conclusion</p> <p>Inclusion of buprenorphine on state Medicaid formularies appears to be a key element in ensuring that patients have access to this state-of-the-art treatment option. Other potential barriers to the diffusion of buprenorphine require identification, and the value of additional state-level policies to promote its use should be evaluated.</p

Gas exchange, δ13C, and heterotrophy for Castilleja linariifolia and Orthocarpus tolmiei, facultative root hemiparasites on Artemisia tridentata

Journal ArticleGas exchange and carbon isotope ratios were measured on 2 facultative hemiparasites, Castilleja linarifolia Benth. (Indian paintbrush; Scrophulariaceae) and Orthocarpus tolmiei I-I. & A. (Tolmie owl clover; Scrophulariaceae), and their Artemisia tridentata L. (big sagebrush; Asteraceae) hosts. Photosynthetic rates differed greatly between years; rates in 1995 were more than double those in 1994, likely due to more precipitation and less water stress during 1995. Despite this difference in precipitation, photosynthetic rates for C. linariifolia were not different from those of their hosts for either year. However, carbon isotope ratios of C. linariifolia and O. tolmiei were up to 30/00 more negative than those of their A. tridentata hosts. Using measured δ13C ratios in conjunction with δ13C ratios predicted from gas-exchange measurements, we calculated that C. linariifolia derived, on average, 40% of its leaf carbon heterotrophically. Contrary to current suggestions that high photosynthetic rates of hemiparasites are an indication of reduced heterotrophy, C. linariifolia exhibited photosynthetic rates similar to autotrophic plants and used a substantial amount of host-derived carbon. Moreover, this evidence shows that manipulation of a heterotrophic carbon supply transcends obligate hemiparasites to include those plants whose parasitism is facultative

A Model for Rigorously Applying the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework in the Design and Measurement of a Large Scale Collaborative Multi-Site Study

Background This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners. Methods The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline. Discussion The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations. Trial registration NCT02672150. Retrospectively registered on 22 January 2016

An Overview of Research and Evaluation Designs for Dissemination and Implementation

The wide variety of dissemination and implementation designs now being used to evaluate and improve health systems and outcomes warrants review of the scope, features, and limitations of these designs

Job stress and poor sleep quality: Data from an American sample of full-time workers

Given the associations between poor quality sleep and health, it is important to consider whether job stressors are related to sleep-related outcomes. Studies from Europe and Japan suggest that these stressors negatively impact sleep, but there are few studies of job stressors and sleep quality that draw upon large representative samples of workers in the USA. Using data collected via telephone interviews from a nationally representative random sample of 1715 American full-time employees, this research considers three dependent variables of past-month poor sleep quality: number of days the respondent had difficulty initiating sleep, number of days of difficulty maintaining sleep, and number of days of non-restorative sleep. Negative binomial regression was used to estimate a count data model of the associations between the frequency of these three types of poor sleep quality and the job stressors of work overload, role conflict, autonomy, and repetitive tasks, while controlling for socio-demographic characteristics. The average American worker reported 5.3 days of difficulty falling asleep, 6.6 days of trouble staying asleep, and 5.0 days of trouble waking up for work in the past month. Across the three types of poor sleep quality, work overload was positively associated with the frequency of poor sleep quality. Role conflict was positively associated with difficulty initiating sleep and non-restorative sleep. Repetitive tasks were associated with more days of difficulty initiating sleep and maintaining sleep. Job autonomy was negatively associated with non-restorative sleep. Given that sleep quality is associated with other health outcomes, future research should continue to explore the associations between job-related stressors, sleep quality, and workers' health status.USA Job stress Sleep Full-time workers Employment