The Experts below are selected from a list of 294 Experts worldwide ranked by ideXlab platform
Richard Saitz - One of the best experts on this subject based on the ideXlab platform.
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marijuana use and achievement of abstinence from alcohol and other drugs among people with substance dependence a prospective cohort study
Drug and Alcohol Dependence, 2014Co-Authors: Mohammadali Mojarrad, Jeffrey H Samet, Michael Winter, Debbie M Cheng, Richard SaitzAbstract:Abstract Background Many with alcohol and other drug dependence have concurrent marijuana use, yet it is not clear how to address it during addiction treatment. This is partially due to the lack of clarity about whether marijuana use impacts one's ability to achieve abstinence from the target of addiction treatment. We examined the association between marijuana use and abstinence from other substances among individuals with substance dependence. Methods A secondary analysis of the Addiction Health Evaluation And Disease management study, a randomized trial testing the effectiveness of chronic disease management. Individuals met criteria for drug or alcohol dependence and reported recent drug (i.e. opioid or stimulant) or heavy alcohol use. Recruitment occurred largely at an inpatient detoxification unit, and all participants were referred to Primary Medical Care. The association between marijuana use and later abstinence from drug and heavy alcohol use was assessed using longitudinal multivariable models. Results Of 563 study participants, 98% completed at least one follow-up assessment and 535 (95%) had at least one pair of consecutive assessments and were included. In adjusted analyses, marijuana use was associated with a 27% reduction in the odds of abstinence from drug and heavy alcohol use (adjusted odds ratio 0.73 [95% CI, 0.56–0.97], P = 0.03). Conclusions Marijuana use among individuals with alcohol or other drug dependence is associated with a lower odds of achieving abstinence from drug and heavy alcohol use. These findings add evidence that suggests concomitant marijuana use among patients with addiction to other drugs merits attention from clinicians.
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emergency department and hospital utilization among alcohol and drug dependent detoxification patients without Primary Medical Care
American Journal of Drug and Alcohol Abuse, 2006Co-Authors: Mary Jo Larson, Nicholas J Horton, Richard Saitz, Christine Lloydtravaglini, Jeffrey H SametAbstract:Utilization of emergency department (ED) services and hospitalization among a cohort of substance abusers are described based on structured research interviews with 470 adults without Primary Care admitted to an urban residential detoxification program. Cross-sectional analysis of baseline data of subjects found nearly 19% of subjects went to an ED on 2 or more occasions in the 6 months prior to detoxification and 14% were admitted for an overnight hospitalization. Upon further analysis of past 6-month ED utilization, the following factors were independently associated with increased odds of ED use: White race; at least one month homeless in the past 5 years chronic health condition; injury in past 6 months; and subject perception that their substance abuse interfered with seeking Care from a regular doctor. Subjects with cocaine as a Primary problem had lower odds of ED utilization than a reference group with alcohol as a Primary problem.
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linking alcohol and drug dependent adults to Primary Medical Care a randomized controlled trial of a multi disciplinary health intervention in a detoxification unit
Addiction, 2003Co-Authors: Jeffrey H Samet, Mary Jo Larson, Nicholas J Horton, Kathleen Doyle, Michael Winter, Richard SaitzAbstract:Aim Pragmatic approaches to integration of Medical Care and substance abuse treatment are desired. We assessed the effectiveness of a novel multi-disciplinary clinic for linking patients in a residential detoxification program to Primary Medical Care. Participants We enrolled patients undergoing in-patient detoxification from alcohol, heroin or cocaine who had no Primary Care physician into a randomized controlled trial. The intervention consisted of a clinical evaluation at the detoxification unit in the health evaluation and linkage to Primary Care (HELP) clinic by a nurse, social worker and physician and facilitated referral to an off-site Primary Care clinic. The Primary outcome of interest was attendance at a Primary Care appointment within 12 months. Secondary outcomes assessed over 24 months were addiction severity, health-related quality of life, utilization of Medical and addiction services and HIV risk behaviors. Findings Of the 470 subjects enrolled, 235 were randomized to the HELP clinic intervention. Linkage to Primary Medical Care occurred in 69% of the intervention group compared to 53% in the control group (P = 0.0003). The clinic was similarly effective for subjects with alcohol and illicit drug problems. Randomization to the HELP clinic resulted in no significant differences in secondary outcomes. Conclusions The HELP clinic, a multi-disciplinary clinic located in a detoxification unit, effectively linked alcohol- and drug-dependent individuals to Primary Medical Care. This intervention utilized a ‘reachable moment’, the period of addiction Care, as a window of opportunity for linking substance abusers to Medical Care.
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benefits of linking Primary Medical Care and substance abuse services patient provider and societal perspectives
JAMA Internal Medicine, 2001Co-Authors: Jeffrey H Samet, Peter D Friedmann, Richard SaitzAbstract:Individuals with alcohol and drug use problems may receive health Care from Medical, mental health, and substance abuse providers, or a combination of all three. Systems of Care are often distinct and separate, and substantial opportunities for benefit to patient, provider, and payer are missed. In this article, we outline (1) the possible benefits of linking Primary Care, mental health, and substance abuse services from the perspective of the major stakeholders-Medical and mental health providers, addiction clinicians, patients, and society-and (2) reasons for suboptimal linkage and opportunities for improving linkage within the current health Care system. We also review published models of linked Medical and substance abuse services. Given the potential benefits of creating tangible systems in which Primary Care, mental health, and substance abuse services are meaningfully linked, efforts to implement, examine, and measure the real impact should be a high priority.
Jeffrey H Samet - One of the best experts on this subject based on the ideXlab platform.
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marijuana use and achievement of abstinence from alcohol and other drugs among people with substance dependence a prospective cohort study
Drug and Alcohol Dependence, 2014Co-Authors: Mohammadali Mojarrad, Jeffrey H Samet, Michael Winter, Debbie M Cheng, Richard SaitzAbstract:Abstract Background Many with alcohol and other drug dependence have concurrent marijuana use, yet it is not clear how to address it during addiction treatment. This is partially due to the lack of clarity about whether marijuana use impacts one's ability to achieve abstinence from the target of addiction treatment. We examined the association between marijuana use and abstinence from other substances among individuals with substance dependence. Methods A secondary analysis of the Addiction Health Evaluation And Disease management study, a randomized trial testing the effectiveness of chronic disease management. Individuals met criteria for drug or alcohol dependence and reported recent drug (i.e. opioid or stimulant) or heavy alcohol use. Recruitment occurred largely at an inpatient detoxification unit, and all participants were referred to Primary Medical Care. The association between marijuana use and later abstinence from drug and heavy alcohol use was assessed using longitudinal multivariable models. Results Of 563 study participants, 98% completed at least one follow-up assessment and 535 (95%) had at least one pair of consecutive assessments and were included. In adjusted analyses, marijuana use was associated with a 27% reduction in the odds of abstinence from drug and heavy alcohol use (adjusted odds ratio 0.73 [95% CI, 0.56–0.97], P = 0.03). Conclusions Marijuana use among individuals with alcohol or other drug dependence is associated with a lower odds of achieving abstinence from drug and heavy alcohol use. These findings add evidence that suggests concomitant marijuana use among patients with addiction to other drugs merits attention from clinicians.
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emergency department and hospital utilization among alcohol and drug dependent detoxification patients without Primary Medical Care
American Journal of Drug and Alcohol Abuse, 2006Co-Authors: Mary Jo Larson, Nicholas J Horton, Richard Saitz, Christine Lloydtravaglini, Jeffrey H SametAbstract:Utilization of emergency department (ED) services and hospitalization among a cohort of substance abusers are described based on structured research interviews with 470 adults without Primary Care admitted to an urban residential detoxification program. Cross-sectional analysis of baseline data of subjects found nearly 19% of subjects went to an ED on 2 or more occasions in the 6 months prior to detoxification and 14% were admitted for an overnight hospitalization. Upon further analysis of past 6-month ED utilization, the following factors were independently associated with increased odds of ED use: White race; at least one month homeless in the past 5 years chronic health condition; injury in past 6 months; and subject perception that their substance abuse interfered with seeking Care from a regular doctor. Subjects with cocaine as a Primary problem had lower odds of ED utilization than a reference group with alcohol as a Primary problem.
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linking alcohol and drug dependent adults to Primary Medical Care a randomized controlled trial of a multi disciplinary health intervention in a detoxification unit
Addiction, 2003Co-Authors: Jeffrey H Samet, Mary Jo Larson, Nicholas J Horton, Kathleen Doyle, Michael Winter, Richard SaitzAbstract:Aim Pragmatic approaches to integration of Medical Care and substance abuse treatment are desired. We assessed the effectiveness of a novel multi-disciplinary clinic for linking patients in a residential detoxification program to Primary Medical Care. Participants We enrolled patients undergoing in-patient detoxification from alcohol, heroin or cocaine who had no Primary Care physician into a randomized controlled trial. The intervention consisted of a clinical evaluation at the detoxification unit in the health evaluation and linkage to Primary Care (HELP) clinic by a nurse, social worker and physician and facilitated referral to an off-site Primary Care clinic. The Primary outcome of interest was attendance at a Primary Care appointment within 12 months. Secondary outcomes assessed over 24 months were addiction severity, health-related quality of life, utilization of Medical and addiction services and HIV risk behaviors. Findings Of the 470 subjects enrolled, 235 were randomized to the HELP clinic intervention. Linkage to Primary Medical Care occurred in 69% of the intervention group compared to 53% in the control group (P = 0.0003). The clinic was similarly effective for subjects with alcohol and illicit drug problems. Randomization to the HELP clinic resulted in no significant differences in secondary outcomes. Conclusions The HELP clinic, a multi-disciplinary clinic located in a detoxification unit, effectively linked alcohol- and drug-dependent individuals to Primary Medical Care. This intervention utilized a ‘reachable moment’, the period of addiction Care, as a window of opportunity for linking substance abusers to Medical Care.
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benefits of linking Primary Medical Care and substance abuse services patient provider and societal perspectives
JAMA Internal Medicine, 2001Co-Authors: Jeffrey H Samet, Peter D Friedmann, Richard SaitzAbstract:Individuals with alcohol and drug use problems may receive health Care from Medical, mental health, and substance abuse providers, or a combination of all three. Systems of Care are often distinct and separate, and substantial opportunities for benefit to patient, provider, and payer are missed. In this article, we outline (1) the possible benefits of linking Primary Care, mental health, and substance abuse services from the perspective of the major stakeholders-Medical and mental health providers, addiction clinicians, patients, and society-and (2) reasons for suboptimal linkage and opportunities for improving linkage within the current health Care system. We also review published models of linked Medical and substance abuse services. Given the potential benefits of creating tangible systems in which Primary Care, mental health, and substance abuse services are meaningfully linked, efforts to implement, examine, and measure the real impact should be a high priority.
Colleen A Redding - One of the best experts on this subject based on the ideXlab platform.
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teen reach outcomes from a randomized controlled trial of a tobacco reduction program for teens seen in Primary Medical Care
Pediatrics, 2005Co-Authors: Jack F Hollis, Michael R Polen, Evelyn P Whitlock, Edward Lichtenstein, John P Mullooly, Wayne F Velicer, Colleen A ReddingAbstract:Objective. To test the long-term efficacy of brief counseling plus a computer-based tobacco intervention for teens being seen for routine Medical Care. Methods. Both smoking and nonsmoking teens, 14 to 17 years of age, who were being seen for routine visits were eligible for this 2-arm controlled trial. Staff members approached teens in waiting rooms of 7 large pediatric and family practice departments within a group-practice health maintenance organization. Of 3747 teens invited at ≥1 visits, 2526 (67%) consented and were randomized to tobacco intervention or brief dietary advice. The tobacco intervention was individually tailored on the basis of smoking status and stage of change. It included a 30-second clinician advice message, a 10-minute interactive computer program, a 5-minute motivational interview, and up to two 10-minute telephone or in-person booster sessions. The control intervention was a 5-minute motivational intervention to promote increased consumption of fruits and vegetables. Follow-up smoking status was assessed after 1 and 2 years. Results. Abstinence rates after 2 years were significantly higher for the tobacco intervention arm, relative to the control group, in the combined sample of baseline smokers and nonsmokers (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.03–1.47). Treatment effects were particularly strong among baseline self-described smokers (OR: 2.42; 95% CI: 1.40–4.16) but were not significant for baseline nonsmokers (OR: 1.25; 95% CI: 0.97–1.61) or for those who had “experimented” in the past month at baseline (OR: 0.95; 95% CI: 0.45–1.98). Conclusions. Brief, computer-assisted, tobacco intervention during routine Medical Care increased the smoking cessation rate among self-described smokers but was less effective in preventing smoking onset.
Joachim Szecsenyi - One of the best experts on this subject based on the ideXlab platform.
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quality circles to improve prescribing patterns in Primary Medical Care what is their actual impact
Journal of Evaluation in Clinical Practice, 2004Co-Authors: Michel Wensing, Bjorn Broge, Petra Kaufmannkolle, Edith Andres, Joachim SzecsenyiAbstract:Rationale, aims and objectives Quality circles comprise small group sessions of doctors and written feedback on their individual practice patterns. Although 50% of German Primary Care doctors participate in quality circles, their effectiveness has hardly been evaluated in Germany. This study determined the impact of a large-scale programme of quality circles on quality and costs of prescribing. Method A controlled before‐after study was performed, in which Primary Care doctors were allocated to a quality circles group or a control group. Subjects were 100 000 patients in 1996 and in 1998, who had visited one of 177 doctors in the 3 month registration periods in one region in Germany. The intervention comprised a quality circles programme, comprising 11 sessions and repeated feedback on prescribing. Main outcome measures were proportion of patients who received a prescription, mean prescription costs per patient and proportion of generic prescriptions. Results The absolute numbers of prescriptions decreased in both groups, but the mean prescription costs per patient increased. The quality circles reduced the proportion of patients who received a prescription (OR = 0.86) and the mean prescription costs per patient (B = - 3.99 euro), while it increased the proportion of generic drugs (OR = 1.10). The intervention had intended effects on four of the 15 secondary indicators. Conclusions Large-scale application of quality circles had intended effects on prescribing decisions in Primary Care in Germany. The effects found in this study may reflect better what improvements can be achieved than randomized trials of similar interventions.
Benjamin G Druss - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial of Medical Care management for community mental health settings the Primary Care access referral and evaluation pCare study
American Journal of Psychiatry, 2010Co-Authors: Benjamin G Druss, Silke A Von Esenwein, Michael T Compton, Kimberly J Rask, Liping Zhao, Ruth M ParkerAbstract:Objective: Poor quality of healthCare contributes to impaired health and excess mortality in individuals with severe mental disorders. The authors tested a population-based Medical Care management intervention designed to improve Primary Medical Care in community mental health settings. Method: A total of 407 subjects with severe mental illness at an urban community mental health center were randomly assigned to either the Medical Care management intervention or usual Care. For individuals in the intervention group, Care managers provided communication and advocacy with Medical providers, health education, and support in overcoming system-level fragmentation and barriers to Primary Medical Care. Results: At a 12-month follow-up evaluation, the intervention group received an average of 58.7% of recommended preventive services compared with a rate of 21.8% in the usual Care group. They also received a significantly higher proportion of evidence-based services for cardiometabolic conditions (34.9% versus 27.7%) and were more likely to have a Primary Care provider (71.2% versus 51.9%). The intervention group showed significant improvement on the SF-36 mental component summary (8.0% [versus a 1.1% decline in the usual Care group]) and a nonsignificant improvement on the SF36 physical component summary. Among subjects with available laboratory data, scores on the Framingham Cardiovascular Risk Index were significantly better in the intervention group (6.9%) than the usual Care group (9.8%). Conclusions: M edical Care management was associated with significant improve ments in the quality and outcomes of Primary Care. These findings suggest that Care management is a promising approach for improving Medical Care for patients treated in community mental health settings.
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integrated Medical Care for patients with serious psychiatric illness a randomized trial
Archives of General Psychiatry, 2001Co-Authors: Benjamin G Druss, Robert M Rohrbaugh, Carolyn M Levinson, Robert A RosenheckAbstract:Background This randomized trial evaluated an integrated model of Primary Medical Care for a cohort of patients with serious mental disorders. Methods A total of 120 individuals enrolled in a Veterans Affairs (VA) mental health clinic were randomized to receive Primary Medical Care through an integrated Care initiative located in the mental health clinic (n = 59) or through the VA general medicine clinic (n = 61). Veterans who obtained Care in the integrated Care clinic received on-site Primary Care and case management that emphasized preventive Medical Care, patient education, and close collaboration with mental health providers to improve access to and continuity of Care. Analyses compared health process (use of Medical services, quality of Care, and satisfaction) and outcomes (health and mental health status and costs) between the groups in the year after randomization. Results Patients treated in the integrated Care clinic were significantly more likely to have made a Primary Care visit and had a greater mean number of Primary Care visits than those in the usual Care group. They were more likely to have received 15 of the 17 preventive measures outlined in clinical practice guidelines. Patients assigned to the integrated Care clinic had a significantly greater improvement in health as measured by the physical component summary score of the 36-Item Short-Form Health Survey than patients assigned to the general medicine clinic (4.7 points vs −0.3 points, P Conclusion On-site, integrated Primary Care was associated with improved quality and outcomes of Medical Care.