Interdisciplinary Approach to Improve Access to Medication-Assisted Therapy in Detroit for Opioid Dependence

Medical Schoolhttps://deepblue.lib.umich.edu/bitstream/2027.42/149416/1/MarinaHaque_1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149416/2/MarinaHaque_2.pd

Prevalence of Uncontrolled Hypertension in Primary Care Settings in Al Seeb Wilayat, Oman

Objectives: This study aimed to estimate the prevalence of uncontrolled hypertension (HTN) among Omani hypertensive patients, on treatment and under primary health care (PHC) follow-up in Al Seeb Wilayat, Oman. Socio-demographic and clinical factors were explored for possible influence on blood pressure (BP) control. Methods: Based on an assumption of 50% prevalence of uncontrolled HTN, a retrospective data collection was conducted on the last three follow-up visits of 411 randomly selected Omani adults (≥18 years) from 3,459 hypertensive patients. Adequate BP control was defined using criteria from 7th Report of the Joint National Committee on Prevention Detection Evaluation & Treatment of High Blood Pressure (JNC-7). A P value of <0.05 and odds ratios with 95% confidence interval were used to assess for association. Results: The targets for adequate BP control were achieved in 39% of the studied patients (95% confidence interval [CI]: 34–44%). Lower BP control was found among hypertensives with diabetes (6.4%, P = <0.001) and renal disease (18.5%, P = 0.02); those with cardiovascular disease (CVD) showed relatively better control (58%). Age and gender had no impact on BP control. Most patients were only on one (24%) or two (47%) antihypertensive medications, the most frequently used being β-blockers (58.2%) and diuretics (56.3%). Conclusion: HTN is not adequately controlled in over 60% of treated patients; the presence of co-morbidity and less than aggressive treatment are significant contributors. Improving the quality of HTN care is a priority; effective efforts should be undertaken to improve BP control.

Barriers to Accessing Buprenorphine in the Primary Care Setting in the City of Detroit and Pertinent Policy Recommendations: A Consultancy Report for the Detroit Health Department

Multiple barriers exist to prescribing and accessing medication-assisted therapy (MAT) for opioid use disorder; these disparities are even higher in cities like Detroit. In order to analyze the barriers to prescribing MAT in Detroit, particularly Buprenorphine/Naloxone, a semi-structured questionnaire was developed. From February to April 2019, 18 interviews were conducted amongst individuals identified as stakeholders in the epidemic. The three most commonly identified barriers to prescribing MAT, especially Buprenorphine/Naloxone, included lack of communication amongst stakeholders, insufficient clinical support for clinicians, and Medicaid insurance barriers. Recommended policy interventions include 1) facilitation of improved stakeholder engagement to increase awareness of MAT efficacy and ability to be integrated into primary care practice; 2) Creation of a platform to support primary care providers in offering MAT; 3) Engagement with policymakers on Medicaid insurance reform to improve the accessibility of MAT.https://deepblue.lib.umich.edu/bitstream/2027.42/150101/1/Detroit Health Department Final Report.docxDescription of Detroit Health Department Final Report.docx : Main articl