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Interventions to reduce tobacco use in people experiencing homelessness
Primary Care Providersâ Judgments of Opioid Analgesic Misuse in a Community-Based Cohort of HIV-Infected Indigent Adults
BackgroundPrimary care providers (PCPs) must balance treatment of chronic non-cancer pain with opioid analgesics with concerns about opioid misuse.ObjectiveWe co-enrolled community-based indigent adults and their PCPs to determine PCPsâ accuracy of estimating opioid analgesic misuse and illicit substance use.DesignPatient-provider dyad study.ParticipantsHIV-infected, community-based indigent adults (âpatientsâ) and their PCPs.Main measuresUsing structured interviews, we queried patients on use and misuse of opioid analgesics and illicit substances. PCPs completed patient- and provider-specific questionnaires. We calculated the sensitivity, specificity, and measures of agreement between PCPsâ judgments and patientsâ reports of opioid misuse and illicit substance use. We examined factors associated with PCPsâ thinking that their patients had misused opioid analgesics and determined factors associated with patientsâ misuse.Key resultsWe had 105 patient-provider dyads. Of the patients, 21 had misused opioids and 45 had used illicit substances in the past year. The sensitivity of PCPsâ judgments of opioid analgesic misuse was 61.9% and specificity, 53.6% (Kappa score 0.09, pâ=â0.10). The sensitivity of PCPsâ judgments of illicit substance use was 71.1% and specificity, 66.7% (Kappa score 0.37, p <0.001). PCPs were more likely to think that younger patients (Adjusted odds ratio (AOR) 0.89, 95% CI 0.84-0.97), African American patients (AOR 2.53, 95% CI 1.05-6.07) and those who had used illicit substances in the past year (AOR 3.33, 95% CI 1.35-8.20) had misused opioids. Younger (AOR 0.94, 95% CI 0.86-1.02) and African American (AOR 0.71, 95% CI 0.25-1.97) patients were not more likely to report misuse, whereas persons who had used illicit substances were (AOR 3.01, 95% CI 1.04-8.76).ConclusionPCPsâ impressions of misuse were discordant with patientsâ self-reports of opioid analgesic misuse. PCPs incorrectly used age and race as predictors of misuse in this high-risk cohort
A triple threat for COVID-19: Homelessness, tobacco use, and aging
The authors describe here potential solutions to mitigate the risk of COVID-19 among people experiencing homelessness, emphasizing the urgent need for permanent supportive housing. They highlight the opportunities that the COVID-19 pandemic offers to heighten awareness of the harms of tobacco use and the benefits from smoking cessation. They also describe challenges to accessing telehealth primary care for people experiencing homelessness, and the roles that primary care providers and pharmacists can take to mitigate barriers to access healthcare and smoking cessation services.https://deepblue.lib.umich.edu/bitstream/2027.42/155583/1/Vijayaraghavan article.pd
Mycobacterium massiliense BRA100 strain recovered from postsurgical infections: resistance to high concentrations of glutaraldehyde and alternative solutions for high level disinfection
Perceptions of clinicians and staff about the use of digital technology in primary care: qualitative interviews prior to implementation of a computer-facilitated 5As intervention
SMOKING BEHAVIORS IN A COMMUNITY-BASED COHORT OF HIV-INFECTED UNSTABLY HOUSED AND HOMELESS ADULTS
Engaging Adults Experiencing Homelessness in Smoking Cessation Through Large-Scale Community Service Events
A Qualitative Examination of Smoke-Free Policies and Electronic Cigarettes Among Sheltered Homeless Adults.
Disparities in receipt of 5As for smoking cessation in diverse primary care and HIV clinics.
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