Effect of the Bathing Without a Battle Training Intervention on Bathing-Associated Physical and Verbal Outcomes in Nursing Home Residents with Dementia: A Randomized Crossover Diffusion Study

To evaluate the effectiveness of the Bathing Without a Battle intervention in reducing physical and verbal aggressive behaviors for nursing home residents with dementia

United States county-level characteristics associated with a mismatch between opioid overdose mortality and availability of opioid treatment facilities, multivariable analysis (n=3,130).

United States county-level characteristics associated with a mismatch between opioid overdose mortality and availability of opioid treatment facilities, multivariable analysis (n=3,130).</p

The geographic distribution of risk-availability mismatch counties, where mismatch is defined as counties that have below national rates of buprenorphine providers in 2019, and above national rates of overdose mortality in 2018.

The geographic distribution of risk-availability mismatch counties, where mismatch is defined as counties that have below national rates of buprenorphine providers in 2019, and above national rates of overdose mortality in 2018.</p

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BackgroundOpioid overdose deaths in the United States remain a major public health crisis. Little is known about counties with high rates of opioid overdose mortality but low availability of opioid use disorder (OUD) treatment facilities. We sought to identify characteristics of United States (US) counties with high rates of opioid overdose mortality and low rates of opioid treatment facilities.MethodsRates of overdose mortality from 3,130 US counties were compared with availability of opioid treatment facilities that prescribed or allowed medications for OUD (MOUD), from 2018-2019. The outcome variable, “risk-availability mismatch” county, was a binary indicator of a high rate (above national average) of opioid overdose mortality with a low (below national average) rate of opioid treatment facilities. Covariates of interest included county-level sociodemographics and rates of insurance, unemployment, educational attainment, poverty, urbanicity, opioid prescribing, depression, heart disease, Gini index, and Theil index. Multilevel logistic regression, accounting for the clustering of counties within states, was used to determine associations with being a “risk-availability mismatch” county.ResultsOf 3,130 counties, 1,203 (38.4%) had high rates of opioid overdose mortality. A total of 1,098 counties (35.1%) lacked a publicly-available opioid treatment facility in 2019. In the adjusted model, counties with an additional 1% of: white residents (odds ratio, OR, 1.02; 95% CI, 1.01-1.03), unemployment (OR, 1.11; 95% CI, 1.05-1.19), and residents without insurance (OR, 1.04; 95% CI, 1.01-1.08) had increased odds of being a mismatch county. Counties that were metropolitan (versus non-metropolitan) had an increased odds of being a mismatch county (OR, 1.85; 95% CI, 1.45-2.38).ConclusionAssessing mismatch between treatment availability and need provides useful information to characterize counties that require greater public health investment. Interventions to reduce overdose mortality are unlikely to be effective if they do not take into account diverse upstream factors, including sociodemographics, disease burden, and geographic context of communities.</div

United States county-level characteristics associated with a mismatch between opioid overdose mortality and availability of opioid treatment facilities (versus non-mismatch counties), accounting for mid-group counties^a, multivariable analysis (n=3,130).

a. Mid-group counties are those with drug overdose mortality rates that are within 0.5 standard deviations of the national average for overdose mortality deaths, and OUD treatment facility rates that are within 0.5 standard deviations of the national average of OUD treatment facilities. *P (DOCX)</p

The geographic distribution of risk-availability mismatch counties.

Mismatch counties are those with below national rates of opioid treatment facilities in 2019 and above national rates of overdose mortality in 2018.</p

Characteristics of United States counties (n=3,130) with a risk-availability mismatch between drug overdose mortality and opioid treatment facilities ^a.

Characteristics of United States counties (n=3,130) with a risk-availability mismatch between drug overdose mortality and opioid treatment facilities a.</p