Housing First for People with Opioid Use disorder (OUD) and engagement with Medication-assisted Treatment (MAT) and Harm Reduction Services

Intro: Opioid Use Disorder (OUD)is one of the most prevalent and deadly SUD’s in the country and many barriers exist for individuals living with homelessness and concurrent psychiatric illnesses when hoping to engage in Medication-Assisted-Recovery/Treatment (MAR/MAT). The current study evaluates the Pathways to Housing PA’s (PTHPA) Housing First(HF) model which provides scatter-site housing with social and maintenance services to individuals with a history of chronic homelessness and a diagnosis of OUD. Methods: A retrospective chart analysis was completed for to assess factors relating to MAT engagement using PTHPA’s Credible BH recording system. MAT engagement prior to HF, psychiatric, homelessness, and medical history were all collected from a Psychiatric Assessment performed upon admission into the HF program. MAT retention and engagement during HF was obtained from self-reported information provided in case notes from PTHPA team members. Results: 76.7% of people engaged in MAT with methadone or buprenorphine treatment after being housed for at least 2 months (n=133). Re-engagement in MAT was higher in individuals who had prior MAT participation prior to the housing first intervention. Years homeless, age and race did not have a significant association with MAT participation following the HF intervention, although gender was associated with different levels of MAT participation between males and females. 23.33% of individuals were able to retain/stay on MAT prior to engaging in HF. 81.375% of individuals who engaged in MAT during the HF intervention were able to retain/stay on MAR by the end of the recording period. Conclusion: There was a significant association of increased MAT engagement in individuals with prior MAR participation. The study at hand suggests that a scatter-site HF model with adequate social service and MAR support can be associated with greater rates of retention in MAR while supporting higher rates of MAR participation in individuals experiencing chronic homelessness and primary OUD than the general population

The trends in DTCA and effects of DTCA by pharmaceutical firms in the United States

The Direct-to-Consumer Advertising (DTCA) of pharmaceutical firms has been defined as an attempt of pharmaceutical companies to advertise products directly to patients (comsumers). Pharmaceutical DTCA has been criticized due to its inappropriateness and some urged the need to strengthen regulations. The DTCA has an impact on the public from both a benefit and harm concern. The purpose of this study is to investigate the current trend of pharmaceutical DTCA in the US and its effect on patients, physicians, and drug utilization. The methodology used in the research is literature review and semi-structured interview. The pharmaceutical DTCA showed reduction in total spending with the television advertising as the biggest channel of DTCA. The small channel market of advertising was the online approach where three-digit growth of 109% was demonstrated. The DTCA affected the physician-patient relationship as well as patient satisfaction. Patients who received the medication associated with DTCA showed higher satisfaction by 43% compared to those receiving other medications. The under-diagnosed conditions, such as depression, could potentially benefit from pharmaceutical DTCA by increasing the awareness regarding those diseases. The advertising of Tegaserod, a medication for irritable bowel syndrome indicated the increasing awareness of the disease along with increasing numbers of Tegaserod prescriptions. The increase of drug utilization by pharmaceutical DTCA seemed to be beneficial in the treatment of benign prostatic hypertrophy. The advertising of second line drugs resulted in an increase of the first line drug utilization by two times compared to the second line drug utilization. The benefit of pharmaceutical DTCA included enhancing appropriate drug utilization by increasing awareness due to diseases such as benign prostatic hypertrophy. The DTCA might cause potential harm by interfering with a physician’s decision regarding prescription drug choice. Additional studies should focus on the type and content of DTCA. The limitation of the study was lack of available data on pharmaceutical DTCA spending to the public

Beyond The Waiver Training: Practical Tips You May Not Have Learned

Objectives Understand the critical importance of philosophy, structure, and access in MAT Share practical tips for starting MAT in your practice Discuss lessons learned with developing a MAT progra

High Retention in an FQHC MOUD Program Despite Substantial Vulnerabilities in Population

Background: Seventy-thousand people in Philadelphia use heroin, and another 50,000 misuse prescription opioids. Philadelphia has increased its capacity for medication for opioid use disorder (MOUD) with buprenorphine from 100 slots in 2017 to 2,906 as of December 2018, but clearly there is still a need for thousands of more treatment slots. Additionally, recent evaluations reveal people from vulnerable populations, including homeless, non-white, and those with chronic medical diseases, have compounded difficulty accessing MOUD, even if there is sufficient capacity. Our objective was to describe and report initial outcomes of a low-threshold MOUD program at our Federally Qualified Health Center (FQHC) in Philadelphia. Methods: We followed 79 patients at our FQHC from their time of initiation until their unplanned treatment termination. Additionally, the relationship of time retained in treatment was compared against homelessness status or cocaine use at baseline through Kaplan-Meier Survival estimates. Results: 3 month retention: 82%. 6 month retention: 63%. No significant differences in treatment retention were found between individuals experiencing homelessness vs. not homeless (p=0.25) and cocaine use vs. no cocaine use (p=0.12). Conclusions: Our FQHC MOUD Program engaged a high level of marginalized groups facing multiple vulnerabilities, and retained them in treatment at rates comparable or higher than reported figures from other FQHCs. This shows that the low-threshold, group based model integrated into a primary care setting shows promise in increasing access to and retention in MOUD services

LexOWL: A Bridge from LexGrid to OWL

The Lexical Grid project is an on-going community driven initiative that provides a common terminology model to represent multiple vocabulary and ontology sources as well as a scalable and robust API for accessing such information. In order to add more powerful functionalities to the existing infrastructure and align LexGrid more closely with various Semantic Web technologies, we introduce the LexOWL project for representing the ontologies modeled within the LexGrid environment in OWL (Web Ontology Language). The crux of this effort is to create a “bridge” that functionally connects the LexBIG (a LexGrid API) and the OWL API (an interface that implements OWL) seamlessly. In this paper, we discuss the key aspects of designing and implementing the LexOWL bridge. We compared LexOWL with other OWL converting tools and conclude that LexOWL provides an OWL mapping and converting tool with well-defined interoperability for information in the biomedical domain

Housing First for People with Opioid Use Disorder (OUD)

Introduction Philadelphia’s opioid crisis has subsequently resulted in an increase in unsheltered individuals. Significant barriers in healthcare access exist for individuals experiencing homelessness and substance use disorders, often leading to poor health outcomes and significant disease burden. Objective This study’s purpose is to determine the prevalence of physical and mental illness among individuals with experiences of homelessness and OUD upon entry to a permanent supportive housing program through Pathways to Housing PA (PTHPA). Methods: This study is a cross-sectional analysis of physical and mental health conditions of individuals who entered PTHPA’s housing program by July 2018. All individuals included had a primary diagnosis of OUD. Results: Of the 83 individuals included, 42 (50.6%) had at least one chronic illness, 60 (72.2%) had a positive Hepatitis C antibody, and 22 (27%) had HIV/AIDS. Additionally, 90.3% of individuals had at least one psychiatric diagnosis, the most prevalent of which were mood disorders (75%). Most common psychiatric diagnoses included major depressive disorder (54%) and post-traumatic stress disorder (41%). Conclusions: The results show that there is a complex burden of disease among individuals with OUD entering PTHPA’s HF program. Understanding these health needs can inform future adjustments and adaptations to provide care for these populations. Importantly, these preliminary results will help inform a larger study on the program, evaluating the association of permanent supportive housing with engagement in treatment for OUD, along with factors like medical and psychiatric diagnoses and their influences on health and treatment outcomes

Emergency Medicine Palliative Care Access (EMPallA): Preliminary Data from a Multi-Center Randomized Controlled Trial

Introduction: Emergency department (ED)-initiated palliative care has been shown to improve patient-centered outcomes in older adults with serious illnesses, but the optimal modality for providing such interventions is unknown. The EMPallA trial compares nurse-led, telephonic case management with specialty, outpatient palliative care on: 1) patient quality of life (QOL); 2) healthcare utilization; 3) loneliness and symptom burden; and 4) caregiver strain, QOL, and bereavement. Objective: Summarize preliminary demographic and QOL data for the EMPallA cohort. Methods: A pragmatic, parallel, two-arm randomized controlled trial is enrolling 1350 ED patients across 9 EDs over 3 years to compare the effectiveness of palliative care models. Eligible patients have end-stage heart failure, renal disease, chronic obstructive pulmonary disease (COPD), or cancer. Baseline data is collected at bedside using surveys. Functional Assessment of Cancer Therapy - General (FACT-G) QOL scores are rescaled into T-scores based on general US and cancer patient samples, standardized with mean 50 and standard deviation 10. Results: 138 patients enrolled from April 16 to October 16, 2018. Average age was 69 years; 55% were female, and 55% were white. Advanced cancer was most prevalent (48%), followed by heart failure (24%), COPD (23%), and end-stage renal disease (15%). Average FACT-G T-scores were 41 (general population) and 40 (cancer patients), which are below population means of 50 by more than 5, a clinically-meaningful difference. Discussion: This gender-balanced, racially-diverse cohort stands to benefit in QOL from palliative care. When trial enrollment and follow-up are complete, the impact of interventions can be assessed

Attitudes Surrounding a Community-Based Fitness Intervention at an Urban FQHC

BACKGROUND AND OBJECTIVES: The population surrounding an urban federally qualified health center (FQHC) in Philadelphia has poorer health than Philadelphia overall. Community residents identified aerobics and dance classes as very important services or programs that an FQHC might provide. We sought to measure the impact of participation in a resident physician-led, patient-centered fitness and nutrition class on participants’ attitudes, knowledge, and self-efficacy regarding their health. METHODS: An urban line dancing class and brief healthy eating intervention for adults was held at a YMCA adjacent to a residency-affiliated FQHC weekly for 8 weeks. Pre/postsurveys were administered to assess attitudes and confidence toward physical activity and healthy lifestyles. RESULTS: Participants’ self-assessment of health and levels of physical activity improved. Confidence in performing everyday activities, doing regular exercise and exercising without making symptoms worse increased. A significant decrease in participants’ physical activity gratification was observed. Participants’ confidence improved in reading food labels for health, but confidence in eating a balanced diet did not improve. CONCLUSIONS: A resident-led fitness and nutrition class, tailored to perceived community needs, generated significant interest and sustained participation. This pilot study furthered development of community infrastructure addressing health, nutrition, and overall fitness, and the results reflect opportunities and challenges of engaging communities in physical fitness

Developing an Action Learning Community Advocacy/Leadership Training Program for Community Health Workers and Their Agencies to Reduce Health Disparities in Arizona Border Communities

Community health workers (CHWs) make unique and important contributions to society. They serve as patient advocates, educators, and navigators in our health care system and a growing body of research indicates that they play an important role in the effective delivery of prevention and treatment services in underserved communities. CHWs also serve as informal community leaders and advocates for organizational and community change, providing valuable insiders\u27 insights about health promotion and the interrelatedness of individuals, their community, its institutions, and the surrounding environment. Accion Para La Salud or Action for Health (Accion) is a CDC-funded community based participatory research (CBPR) project addressing the social determinants of health affecting health-related behaviors with the ultimate goal of creating a mode in which community advocacy to address the systems and environmental factors influencing health is integrated into the role of CHWs working in chronic disease prevention. Kingdon\u27s three streams theory and the social ecological model provide an overarching conceptual framework for Accion. The curriculum and training are also grounded in the theory and principles of action learning, which emphasizes learning by doing, teamwork, real-world projects, and reflection. The curriculum was delivered in four workshops over thirteen months and included longitudinal team projects, peer support conference calls, and technical assistance visits. It is now being delivered to new groups of CHWs in Arizona using a condensed two-day workshop format