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AbstractPurpose: This article summarizes lessons learned from five AHRQ grants to implement Medication for Opioid Use Disorder (MOUD) in rural primary care practices. Methods: Lessons learned were extracted from quarterly and annual grantee progress reports, minutes from quarterly virtual meetings, and minutes and notes from annual grantee in-person meetings. The lessons learned were drafted by the authors and reviewed by the grantees for accuracy. Results:The experience of these projects suggest that recruiting providers in rural areas and engaging them to initiate and sustain provision of MOUD is very difficult. Innovative approaches and providing supports are required for supporting providers to overcome barriers. Implications: Implementation of MOUD in rural primary care is challenging but success is more likely if implementers are attentive to the needs of individual providers, are flexible and tailor implementation to the local situation, and provide on-going support.

Purpose This article summarizes lessons learned from five AHRQ grants to implement Medication for Opioid Use Disorder (MOUD) in rural primary care practices.Methods Lessons learned were extracted from quarterly and annual grantee progress reports, minutes from quarterly virtual meetings, and minutes and notes from annual grantee in-person meetings. The lessons learned were drafted by the authors and reviewed by the grantees for accuracy.Results The experience of these projects suggest that recruiting providers in rural areas and engaging them to initiate and sustain provision of MOUD is very difficult. Innovative approaches and providing supports are required for supporting providers to overcome barriers.Implications Implementation of MOUD in rural primary care is challenging but success is more likely if implementers are attentive to the needs of individual providers, are flexible and tailor implementation to the local situation, and provide on-going support.

To gain insight on the knowledge, opinions, barriers, and practices of pharmacists regarding drug risk-minimization tools.

BACKGROUND: The cyclooxygenase-2 (COX-2) selective nonsteroidal antiinflammatory drugs (NSAIDs) celecoxib and rofecoxib (before its removal) are marketed as having fewer gastrointestinal (GI)-related complications than nonselective NSAIDs. However, adverse reaction data suggest that the use of COX-2 selective NSAIDs is associated with clinically significant GI events.OBJECTIVE: To assess whether patients receiving celecoxib and rofecoxib have a greater underlying disease burden than patients prescribed nonselective NSAIDs.METHODS: The study population consisted of members of 11 health plans, aged >34 years, with a pharmacy claim for celecoxib or rofecoxib or a nonselective NSAID dispensed between February 1, 1999, and July 31, 2001, who had been continuously enrolled for >364 days before the dispensing date. Celecoxib and rofecoxib patients were randomly selected without replacement from a pool of eligible users in each of the 30 months. Nonselective NSAID users were randomly chosen without replacement within each month on a 2:1 ratio to cases; they could be chosen in more than one month. Univariate analyses comparing 9000 cases and 18 000 controls were performed, followed by a multiple logistic regression analysis conditioned on time.RESULTS: Increasing age, treatment by a rheumatologist or an orthopedic specialist, treatment with a high number of different medications in the past year, treatment with oral corticosteroids in the past year, and having had a previous GI bleed increased the likelihood of receiving celecoxib or rofecoxib, whereas treatment with a high number of nonselective NSAID prescriptions in the past year decreased it. Treatment with a high number of different medications was a predictor of increased prevalence of underlying diabetes mellitus and cardiovascular disease.CONCLUSIONS: Patients having a greater underlying disease burden were more likely to receive COX-2 selective NSAIDs than nonselective ones. Paradoxically, patients at higher risk for cardiovascular disease were channeled toward treatment with COX-2 selective NSAIDs, many of which may confer an increased risk of acute myocardial infarction and other adverse cardiovascular outcomes.

A sample of U.S. adults were asked questions to assess their knowledge of oral cancer as part of the 1990 Health Promotion and Disease Prevention Supplement of the National Health Interview Survey. Tobacco use was the only risk factor most adults identified correctly. Only 25 percent of those surveyed could identify one sign of oral cancer. Overall, there is extensive misinformation and a general lack of knowledge.

Background For evaluating measles vaccine efficacy (VE) in the field, some investigators have suggested that an overall attack rate level of 5% or more in a randomly mixing population is sufficient to provide equal exposure to the viral agent in both vaccinated and unvaccinated groups. It is not clear, however, If this assumption is valid given the effect of herd immunity. Methods We created a computer simulation model based on the stochastic extension of the Reed-Frost model and tested for variation in bias in VE estimation due to herd immunity, based on runs of 200 trials. Results At higher levels of attack rate, the degree of herd immunity decreases, as does the percentage of trials with bias in VE estimation. The two main factors that affect the level of attack rate are the probability of adequate contact and the number of susceptibles. At a given level of attack rate, the number of susceptibles is positively associated with the percentage of biased trials in VE estimation. Since vaccination reduces the number of susceptibles, we also observe that when controlling for attack rate, higher vaccination coverage results in lower bias in VE estimation. Conclusions The results show that the assumption of no bias when the attack rate is 5% or more becomes Increasingly true when a large percentage of a randomly mixing population is immune.