37 results on '"Benjamin J. Oldfield"'
Search Results
2. Drive Time to Addiction Treatment Facilities Providing Contingency Management across Rural and Urban Census Tracts in 6 US States
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Paul J. Joudrey, Kevin Chen, Benjamin J. Oldfield, Emma Biegacki, and David A. Fiellin
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Psychiatry and Mental health ,Pharmacology (medical) - Published
- 2023
3. Group well-child care as a facilitator of psychoeducation: pediatrics residents’ perspectives
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Patricia Faraone Nogelo, Benjamin J Oldfield, Ada M Fenick, and Marjorie S Rosenthal
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Public Health, Environmental and Occupational Health ,Education - Abstract
Psychoeducation, where clinicians teach problem-solving skills in a supportive environment, can help address families’ social vulnerabilities and promote well-being. Group well-child care (GWCC) may provide unique opportunities for pediatric residents to improve their skills in psychoeducation. Our aim was to characterize pediatric residents’ perspectives and experiences of communication while conducting both individual well-child care and GWCC. We used a longitudinal qualitative study design to conduct 15 semistructured interviews with five pediatric residents who facilitated GWCC. Using the constant comparative method, we characterized pediatric residents’ perspectives and experiences of communication while conducting both individual well-child care and GWCC. Four themes emerged. Residents perceived that GWCC (i) enabled families to honestly share their knowledge and parenting practices, (ii) allowed time and a space for families to share personal stories and scenarios, (iii) facilitated discussions of maternal health and psychosocial matters, toward which residents felt ambivalence, and (iv) fostered skills in psychoeducation that transferred to the rest of their clinical practice. When pediatric residents lead GWCC, they perceive that they can facilitate key aspects of psychoeducation, enabling them to assist families in meeting complex social needs. Residents describe that they transfer psychoeducation skills learned in GWCC to the rest of their practice.
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- 2023
4. Availability of Specific Programs and Medications for Addiction Treatment to Vulnerable Populations: Results from the Addiction Treatment Locator, Assessment, and Standards (ATLAS) Survey
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Benjamin J. Oldfield, Kevin Chen, Paul J. Joudrey, Emma T. Biegacki, and David A. Fiellin
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Psychiatry and Mental health ,Pharmacology (medical) - Published
- 2023
5. Clinical and Sociodemographic Factors Associated with Telemedicine Engagement in an Urban Community Health Center Cohort During the COVID-19 Pandemic
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Fabiola, Molina, Pamela R, Soulos, Anthony, Brockman, and Benjamin J, Oldfield
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Health Information Management ,Health Informatics ,General Medicine - Published
- 2022
6. Twelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV
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Amy J. Kennedy, Benjamin J. Oldfield, Jessica J. Wyse, Stephen Crystal, Kendall J. Bryant, Kirsha S. Gordon, Amy C. Justice, Kathleen A. McGinnis, E. Jennifer Edelman, Melissa Skanderson, Adam J. Gordon, Julie R. Gaither, Declan T. Barry, Ajay Manhapra, David A. Fiellin, P. Todd Korthuis, Brent A. Moore, and Kevin L. Kraemer
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medicine.medical_specialty ,Social Psychology ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Article ,Cohort Studies ,Opioid Agonist ,Internal medicine ,Opiate Substitution Treatment ,medicine ,Humans ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Opioid use disorder ,Opioid-Related Disorders ,medicine.disease ,Analgesics, Opioid ,Infectious Diseases ,Hiv status ,business ,Methadone ,Buprenorphine ,medicine.drug ,Cohort study - Abstract
Although opioid agonist therapy (OAT) is associated with positive health outcomes, including improved HIV management, long-term retention in OAT remains low among patients with opioid use disorder (OUD). Using data from the Veterans Aging Cohort Study (VACS), we identify variables independently associated with OAT retention overall and by HIV status. Among 7,334 patients with OUD, 13.7% initiated OAT, and 27.8% were retained 12-months later. Likelihood of initiation and retention did not vary by HIV status. Variables associated with improved likelihood of retention included receiving buprenorphine (relative to methadone), receiving both buprenorphine and methadone at some point over the 12-month period, or diagnosis of HCV. History of homelessness was associated with a lower likelihood of retention. Predictors of retention were largely distinct between patients with HIV and patients without HIV. Findings highlight the need for clinical, systems, and research initiatives to better understand and improve OAT retention.
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- 2021
7. Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation
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Jessica E Yager, Benjamin J. Oldfield, Philip A. Chan, Elizabeth Porter, Geliang Gan, Kenneth L. Morford, David A. Fiellin, E. Jennifer Edelman, James Dziura, Deborah H. Cornman, Denise Esserman, and Srinivas B. Muvvala
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medicine.medical_specialty ,Quality management ,Substance-Related Disorders ,Visual analogue scale ,media_common.quotation_subject ,MEDLINE ,HIV Infections ,Context (language use) ,Health Services Accessibility ,Article ,Formative assessment ,Humans ,Medicine ,Pharmacology (medical) ,media_common ,Tobacco Use Cessation ,Teamwork ,business.industry ,Opioid-Related Disorders ,Focus group ,Alcoholism ,Infectious Diseases ,Opioid ,Family medicine ,HIV-1 ,business ,medicine.drug - Abstract
BACKGROUND: We sought to characterize readiness, barriers to and facilitators of providing medications for addiction treatment (MAT) in HIV clinics. SETTING: Four HIV clinics in the US northeast. METHODS: Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness (visual analog scale, less ready[0-0.05). The majority favored integrating MAT into HIV care, but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients; variable experiences with MAT and perceived medication complexity; perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use; local champions; focus on quality improvement and multidisciplinary teamwork. CONCLUSION: Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance specific models.
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- 2021
8. A Blueprint for Community Health Center and Nursing Home Partnership: Testing for COVID-19 among Residents and Staff at Long-term Care Facilities
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Leif Petterson, Suzanne Lagarde, Stan DeCosta, Douglas P. Olson, and Benjamin J. Oldfield
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Patients ,Coronavirus disease 2019 (COVID-19) ,Health Personnel ,Public Health, Environmental and Occupational Health ,Community Health Centers ,Long-Term Care ,Nursing Homes ,Workflow ,Health personnel ,Long-term care ,COVID-19 Testing ,Nursing ,Community health center ,Blueprint ,General partnership ,Humans ,Business ,Nursing homes - Published
- 2021
9. Longitudinal analysis of the prevalence and correlates of heavy episodic drinking and self-reported opioid use among a national cohort of patients with HIV
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Benjamin J. Oldfield, Yu Li, Rachel Vickers‐Smith, Declan T. Barry, Stephen Crystal, Kirsha S. Gordon, Robert D. Kerns, Emily C. Williams, Brandon D. L. Marshall, and E. Jennifer Edelman
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Alcohol Drinking ,Medicine (miscellaneous) ,HIV Infections ,Toxicology ,Opioid-Related Disorders ,Article ,Analgesics, Opioid ,Cohort Studies ,Psychiatry and Mental health ,Cocaine-Related Disorders ,Prevalence ,Humans ,Prospective Studies ,Self Report - Abstract
BACKGROUND: Heavy episodic drinking (HED) is a risk factor for opioid-related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined sociodemographic and clinical correlates of concomitant HED and self-reported opioid use. METHODS: We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self-reported opioid use and created a 4-level composite variable of HED and opioid use. We used multinomial logistic regression to estimate odds of reporting concomitant HED and self-reported opioid use. RESULTS: Among 3,702 PWH, 1,458 (39.4%) reported HED during the study period and 350 (9.5%) reported opioid use. In the multinomial model, compared to reporting neither HED or opioid use, lifetime housing instability (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.01–2.35), VACS Index 2.0 (a measure of disease severity) (aOR 1.14, 95% CI 1.02–1.28), depressive symptoms (aOR 2.27, 95% CI 1.42–3.62), past-year cigarette smoking (aOR 3.06, 95% CI 1.53–6.14), cannabis use (aOR 1.69, 95% CI 1.09–2.62), and cocaine/stimulant use (aOR 11.54, 95% CI 7.40–17.99) were independently associated with greater odds of concomitant HED and self-reported opioid use. Compared to having attended no college, having some college or more (aOR 0.39, 95% CI 0.26–0.59) was associated with lower odds of concomitant HED and self-reported opioid use. CONCLUSIONS: Among PWH, concomitant HED and self-reported opioid use are more common among individuals with depressive symptoms and substance use, structural vulnerabilities, and greater illness severity. Efforts to minimize opioid-related risk should address high-risk drinking as a modifiable risk factor for harm among these groups.
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- 2022
10. Trajectories of Self-Reported Opioid Use Among Patients With HIV Engaged in Care: Results From a National Cohort Study
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Julie R. Gaither, E. Jennifer Edelman, Benjamin J. Oldfield, William C. Becker, Kirsha S. Gordon, Jessica S. Merlin, Declan T. Barry, Robert D. Kerns, Brent A. Moore, Jennifer Brennan Braden, Ajay Manhapra, Yu Li, Amy C. Justice, Stephen Crystal, Lesley S. Park, Melissa Skanderson, Janet P. Tate, Christopher T Rentsch, Emily C. Williams, and Brandon D.L. Marshall
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Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,MEDLINE ,HIV Infections ,Article ,Heroin ,Cohort Studies ,medicine ,Humans ,Pharmacology (medical) ,Medical prescription ,Prospective cohort study ,Aged ,Benzodiazepine ,business.industry ,Middle Aged ,Opioid-Related Disorders ,United States ,Infectious Diseases ,Opioid ,Emergency medicine ,Anxiety ,Female ,medicine.symptom ,business ,Cohort study ,medicine.drug - Abstract
BACKGROUND: No prior studies have characterized long-term patterns of opioid use regardless of source or reason for use among patients with HIV (PWH). We sought to identify trajectories of self-reported opioid use and their correlates among a national sample of PWH engaged in care. SETTING: Veterans Aging Cohort Study, a prospective cohort including PWH receiving care at eight US Veterans Health Administration (VA) sites. METHODS: Between 2002 and 2018, we assessed past year opioid use frequency based on self-reported “prescription painkillers” and/or heroin use at baseline and follow-up. We used group-based trajectory models to identify opioid use trajectories and multinomial logistic regression to determine baseline factors independently associated with escalating opioid use compared to stable, infrequent use. RESULTS: Among 3,702 PWH, we identified four opioid use trajectories: 1) no lifetime use (25%); 2) stable, infrequent use (58%); 3) escalating use (7%); and 4) de-escalating use 11%). In bivariate analysis, anxiety; pain interference; prescribed opioids, benzodiazepines and gabapentinoids; and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. In multivariable analysis, illness severity, pain interference, receipt of prescribed benzodiazepine medications and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. CONCLUSION: Among PWH engaged in VA care, one in 15 reported escalating opioid use. Future research is needed to understand the impact of psychoactive medications and marijuana use on opioid use and whether enhanced uptake of evidence-based treatment of pain and psychiatric symptoms can prevent escalating use among PWH.
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- 2020
11. Guidance for Writing Case Reports in Addiction Medicine
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Richard Saitz and Benjamin J Oldfield
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Psychiatry and Mental health ,medicine.medical_specialty ,Addiction medicine ,business.industry ,Family medicine ,medicine ,MEDLINE ,Pharmacology (medical) ,business - Published
- 2020
12. The Association of Loneliness and Non-prescribed Opioid Use in Patients With Opioid Use Disorder
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Dabely Cruz-Jose, Benjamin J. Oldfield, Douglas P. Olson, John McDonagh, and Cory B. Williams
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medicine.medical_specialty ,business.industry ,010102 general mathematics ,Loneliness ,Opioid use disorder ,Odds ratio ,Logistic regression ,medicine.disease ,01 natural sciences ,Confidence interval ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Internal medicine ,medicine ,Pharmacology (medical) ,030212 general & internal medicine ,0101 mathematics ,medicine.symptom ,Risk factor ,business ,Buprenorphine ,medicine.drug ,Cohort study - Abstract
Objective To investigate the relationship between loneliness and non-prescribed opioid use in patients diagnosed with opioid use disorder (OUD). Methods This was a cohort study conducted at a federally qualified health center (FQHC) in New Haven, CT. Patients who were treated for OUD by health center providers and prescribed buprenorphine were eligible. Participants were asked to complete the UCLA-Loneliness Scale Version 3. From the electronic medical record, we collected patient demographic and clinical characteristics as well as the results of biological fluid testing obtained throughout their treatment course since entry into care. Multivariable logistic regression was performed to identify independent predictors of the detection of non-prescribed opioids within biological fluid. Results Of the 82 patients enrolled in the study, 33 (40.3%) of the participants had at least 1 biological fluid test positive for non-prescribed opioids after maintenance onto buprenorphine treatment. A higher loneliness score was associated with increased odds of non-prescribed opioids (adjusted odds ratio 1.16; 95% confidence interval 1.06-1.27). Patient age, the number of problems on the problems list, and cocaine use were also positively associated with the presence of non-prescribed opioids whereas having diabetes was negatively associated. Conclusions Among the individuals being treated with buprenorphine for OUD, loneliness may be a risk factor for the use of non-prescribed opioids or treatment failure.
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- 2020
13. Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV
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Benjamin J. Oldfield, Kendall J. Bryant, Stephen Crystal, Kevin L. Kraemer, Lynn E. Fiellin, Emily C. Williams, Joseph L. Goulet, Kathleen A. McGinnis, Amy C. Justice, Kathleen M. Akgün, Julie R. Gaither, David A. Fiellin, P. Todd Korthuis, E. Jennifer Edelman, Brandon D.L. Marshall, and Adam J. Gordon
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Male ,Acamprosate ,030508 substance abuse ,Medicine (miscellaneous) ,HIV Infections ,Alcohol use disorder ,Logistic regression ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Medical prescription ,Veterans ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Naltrexone ,Confidence interval ,Alcoholism ,Psychiatry and Mental health ,Clinical Psychology ,Disulfiram ,Female ,Pshychiatric Mental Health ,0305 other medical science ,business ,Alcohol Deterrents ,Demography ,medicine.drug ,Cohort study - Abstract
Introduction Infrequent use of and poor retention on evidence-based medications for alcohol use disorder (MAUD) represent a treatment gap, particularly among people living with HIV (PLWH). We examined predictors of MAUD initiation and retention across HIV status. Methods From Veterans Aging Cohort Study (VACS) data, we identified new alcohol use disorder (AUD) diagnoses from 1998 to 2015 among 163,339 individuals (50,826 PLWH and 112,573 uninfected, matched by age, sex, and facility). MAUD initiation was defined as a prescription fill for naltrexone, acamprosate or disulfiram within 30 days of a new diagnosis. Among those who initiated, retention was defined as filling medication for ≥80% of days over the following six months. We used multivariable logistic regression to assess patient- and facility-level predictors of AUD medication initiation across HIV status. Results Among 10,603 PLWH and 24,424 uninfected individuals with at least one AUD episode, 359 (1.0%) initiated MAUD and 49 (0.14%) were retained. The prevalence of initiation was lower among PLWH than those without HIV (adjusted odds ratio [AOR] 0.66, 95% confidence interval [CI] 0.51–0.85). Older age (for PLWH: AOR 0.78, 95% CI 0.61–0.99; for uninfected: AOR 0.70, 95% CI 0.61–0.80) and black race (for PLWH: AOR 0.63, 95% CI 0.0.49–0.1.00; for uninfected: AOR 0.63, 95% CI 0.48–0.83), were associated with decreased odds of initiation for both groups. The low frequency of retention precluded multivariable analyses for retention. Conclusions For PLWH and uninfected individuals, targeted implementation strategies to expand MAUD are needed, particularly for specific subpopulations (e.g. black PLWH).
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- 2020
14. Demographic and Clinical Correlates of the Cost of Potentially Preventable Hospital Encounters in a Community Health Center Cohort
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Lori Reynolds, Susan B. Roman, Lacey Whitmire, Saamir Pasha, Benjamin J. Oldfield, and Anthony Brockman
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Male ,medicine.medical_specialty ,Leadership and Management ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Community Health Centers ,Community health planning ,Hospital care ,Hospitals ,United States ,Hospitalization ,Community health center ,Family medicine ,Ambulatory ,Cohort ,medicine ,Ambulatory Care ,Diabetes Mellitus ,Humans ,business ,health care economics and organizations ,Demography ,Retrospective Studies - Abstract
This study sought to describe the cost of hospital care for ambulatory care-sensitive conditions (ACSCs) and to identify independent predictors of high-cost hospital encounters related to an ACSC among an urban community health center cohort. The authors conducted a retrospective cohort study of individuals engaged in care in a large, multisite community health center in New Haven, Connecticut, with any Medicaid claims between June 1, 2018 and March 31, 2020. Prevention Quality Indicators of the Agency for Healthcare Research and Quality were used to identify ACSCs. The primary outcome was a high-cost episode of care for an ACSC (in the top quartile within a 7-day period). Multivariable logistic regression was used to identify independent predictors of high-cost episodes by ACSCs among sociodemographic and clinical variables as covariates. Among 8019 included individuals, a total of 751 episodes of hospital care involving ACSCs were identified. The median episode cost was $793, with the highest median cost of care related to heart failure ($4992), followed by diabetes ($1162), and chronic obstructive pulmonary disease ($1141). In adjusted analyses, male gender (
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- 2021
15. Improving Guideline Adherence for Opioid Prescribing in Community Health Centers
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William C. Becker and Benjamin J. Oldfield
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medicine.medical_specialty ,Controlled Substances ,business.industry ,Guideline adherence ,Advisory Committees ,Community Health Centers ,General Medicine ,Pain management ,Opioid prescribing ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Family medicine ,Community health ,Medicine ,Guideline Adherence ,Neurology (clinical) ,Practice Patterns, Physicians' ,business - Published
- 2020
16. Group Well-Child Care and Health Services Utilization: A Bilingual Qualitative Analysis of Parents’ Perspectives
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Patricia F Nogelo, Benjamin J. Oldfield, Ada M. Fenick, Kimberly E Ona Ayala, Marjorie S. Rosenthal, and Marietta Vázquez
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Adult ,Male ,Parents ,medicine.medical_specialty ,Adolescent ,Epidemiology ,Child Health Services ,Child Welfare ,Context (language use) ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Cultural diversity ,Humans ,Medicine ,Multilingualism ,Qualitative Research ,Medical education ,030219 obstetrics & reproductive medicine ,Poverty ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Patient Acceptance of Health Care ,Collective efficacy ,Content analysis ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Qualitative research - Abstract
Objective Alternative primary care structures such as group well-child care (GWCC) may enhance care for families, particularly those subject to structural vulnerabilities such as poverty or restrictive immigration policies. The purpose of this study was to characterize how group dynamics in GWCC impact the perceptions of low-income, immigrant, and/or Spanish-speaking parents of health services. Methods Using Spanish and English interview guides that were conceptually identical, we conducted semi-structured interviews with parents who elected to participate in GWCC at an urban academic center. We drew from directed content analysis, grounded theoretically in the Andersen model of health services utilization. Modeling a bilingual, multicultural analytic strategy, we preserved the narrative of participants in the source language through all stages of analysis. Results From March through August 2017, we interviewed 22 caregivers in their preferred language. Most (82%) were mothers and half spoke Spanish only. Three themes emerged: participants perceived that (1) GWCC facilitates their and their peers' discovery of inherent expertise, which moderates parents' use of health services, (2) GWCC encourages rearrangements of hierarchies of knowledge, professional roles and genders; and (3) in the context of structural vulnerabilities, relationships formed in GWCC facilitate collective efficacy. Conclusions for Practice By considering the self and peer as sources of health-related expertise, GWCC may extend current theoretical models of health services utilization. GWCC provides opportunities to impact health services utilization among families subject to structural vulnerabilities.
- Published
- 2019
17. Cohorting Patients at A Community Health Center: In-Person Well Care, Telemedicine Follow-Ups, And On-Site COVID-19 Testing With Social Determinants Screening
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Laurel B. Shader, Leif Petterson, Jessica Thompson, Gilda DiScala, Frankie Santiago, Victoria Gasca, Elaine Greene, and Benjamin J. Oldfield
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Chronic care ,medicine.medical_specialty ,Telemedicine ,business.industry ,Context (language use) ,Prenatal care ,Community health center ,Family medicine ,Pediatrics, Perinatology and Child Health ,Cohort ,Pandemic ,medicine ,Social determinants of health ,business - Abstract
Program Goals: During the COVID-19 pandemic, anticipatory guidance, developmental surveillance andimmunizations may be postponed At Fair Haven Community Health Care (FHCHC), a multi-site communityhealth center (CHC) in New Haven, CT, serving approximately 18,000 patients (9,000 children), weimplemented cohorting during the period of greatest local impact of the pandemic Our goals were to (1)prioritize well-child care for children due for immunizations, (2) increase the capacity for telemedicine forpatients with chronic illness or acute complaints, and (3) implement on-site COVID-19 testing with socialdeterminants screening Evaluation: We implemented cohorting for pediatric patients at FHCHC on March 12,2020 (for reference, Connecticut's stay-at-home order was signed March 23) Previously scheduled well childcare (WCC) for key age groups - birth to 24 months and 4 to 5 years - were moved to a “clean” site where onlyWCC and prenatal care were offered All other children received telemedicine visits, which could be converted to same-day in-person visits at the discretion of the clinician School-based health center providers were re-purposed to call patients with asthma in need of follow-up using a chronic care model On April 22, 2020,shortly after the neighborhood surrounding FHCHC's main site was identied as a COVID-19 “hot-spot,” weimplemented on-site testing regardless of symptoms, exposure, or prior use of FHCHC services Patientstested on-site were seen prior to their test via telemedicine for symptom assessment and to be screened forsocial determinants using the Accountable Health Communities instrument They were given locally-specicinformation to meet social needs generated by the NowPow platform From March 12 through April 30, wecompleted 3,302 visits for children 0 through 22 years;1,595 (48%) were via telemedicine Younger childrenages 0-5 years had a greater proportion of visits in-person (634, 60%) than children 6-12 years (438, 46%) oradolescents 12-22 years (635, 49%) Visit counts by time, stratied by visit-type, are shown in the Figure FromApril 22 through 30, 2020, we have scheduled 317 visits for on-site testing, 243 (77%) of which werecompleted, 36 of whom were children, all of whom were screened for social determinants of health Discussion: CHCs can cohort children to ensure that preventive care and vaccinations happen in a timelyfashion in the context of an epidemic Responding to local epidemiologic data, CHCs can provide trustingenvironments for surveillance testing Testing for COVID-19 represents a feasible opportunity to screen forsocial determinants of health and facilitate community linkages to meet social needs using electronicplatforms After the COVID-19 pandemic has subsided, CHCs can offer episodic telemedicine visits for children,and can screen for social determinants at various points of contact with families
- Published
- 2021
18. Long-term Patterns of Self-reported Opioid Use, VACS Index, and Mortality Among People with HIV Engaged in Care
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Joëlla W. Adams, Christopher T Rentsch, Benjamin J. Oldfield, E. Jennifer Edelman, Declan T. Barry, Brandon D.L. Marshall, Kirsha S. Gordon, Robert D. Kerns, and Yu Li
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medicine.medical_specialty ,Aging ,Index (economics) ,Social Psychology ,business.industry ,Opioid use ,Public health ,Public Health, Environmental and Occupational Health ,Human immunodeficiency virus (HIV) ,HIV Infections ,Odds ratio ,medicine.disease_cause ,Lower risk ,Confidence interval ,Article ,Analgesics, Opioid ,Cohort Studies ,Infectious Diseases ,Medicine ,Humans ,Self Report ,business ,Cohort study ,Demography ,Veterans - Abstract
Longitudinal analyses of opioid use and overall disease severity among people with HIV (PWH) are lacking. We used joint-trajectory and Cox proportional hazard modeling to examine the relationship between self-reported opioid use and the Veterans Aging Cohort Study (VACS) Index 2.0, a validated measure of disease severity and mortality, among PWH engaged in care. Using data from 2002 and 2018, trajectory modeling classified 20% of 3,658 PWH in low (i.e., lower risk of mortality), 40% in moderate, 28% in high, and 12% in extremely high VACS Index trajectories. Compared to those with moderate VACS Index trajectory, PWH with an extremely high trajectory were more likely to have high, then de-escalating opioid use (adjusted odds ratio [AOR], 95% confidence interval [CI]: 5·17 [3·19–8·37]) versus stable, infrequent use. PWH who report high frequency opioid use have increased disease severity and mortality risk over time, even when frequency of opioid use de-escalates.
- Published
- 2021
19. Addressing Unhealthy Alcohol Use and the HIV Pre-exposure Prophylaxis Care Continuum in Primary Care: A Scoping Review
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Benjamin J. Oldfield and E. Jennifer Edelman
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medicine.medical_specialty ,Social Psychology ,Adolescent ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,HIV Infections ,Primary care ,medicine.disease_cause ,Article ,03 medical and health sciences ,Pre-exposure prophylaxis ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Hiv acquisition ,030505 public health ,Sex Workers ,Primary Health Care ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Continuity of Patient Care ,Care Continuum ,Health psychology ,Infectious Diseases ,Increased risk ,Family medicine ,Pre-Exposure Prophylaxis ,0305 other medical science ,business - Abstract
Individuals with unhealthy alcohol use are at increased risk for HIV acquisition and may benefit from receiving HIV pre-exposure prophylaxis (PrEP) in primary care settings. To date, literature synthesizing what is known about the impact of unhealthy alcohol use on the PrEP care continuum with a focus on considerations for primary care is lacking. We searched OVID Medline and Web of Science from inception through March 19, 2020, to examine the extent, range, and nature of research on PrEP delivery among individuals with unhealthy alcohol use in primary care settings. We identified barriers and opportunities at each step along the PrEP care continuum, including for specific populations: adolescents, people who inject drugs, sex workers, and transgender persons. Future research should focus on identification of candidate patients, opportunities for patient engagement in novel settings, PrEP implementation strategies, and stigma reduction.Indivíduos con dificultades con el uso del alcohol tienen un alto riesgo de contraer VIH y podrían beneficiarse de recibir profilaxis preexposición (PrEP) de VIH en centros de cuidado primario. Hasta este momento, la literatura que sintetiza lo conocido sobre el impacto de las dificultades con el uso del alcohol en el contínuo del cuidado de PrEP, con un enfoque en los centros de cuidado primario, no es suficiente. Buscamos OVID Medline y Web of Science desde sus principios hasta el 19 de marzo, 2020, para examinar el alcance, el rango, y la naturaleza de la investigación sobre el uso de PrEP en los indivíduos con dificultades con el uso del alcohol en centros del cuidado primario. Identificamos las barreras y las oportunidades en cada paso en el contínuo del cuidado de PrEP, incluyendo para grupos específicos: adolescentes, personas que se inyectan drogas, trabajadores sexuales y personas transgéneros. Futuras investigaciones deben enfocarse en la identificación de pacientes apropriados, oportunidades para atraer la atención de los pacientes en sitios inovadores, para implementar PrEP, y para reducir el estigma.
- Published
- 2020
20. Construction of a Pediatrics Risk Score to Predict High Health Care Costs Among a Community Health Center Cohort
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Maryellen Flaherty-Hewitt, Tannaz Sedghi, Benjamin J. Oldfield, Amanda DeCew, Sophia Mun, Douglas P. Olson, Saamir Pasha, and Weiwei Zhu
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medicine.medical_specialty ,Adolescent ,Leadership and Management ,Population ,Pediatrics ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Community health center ,Risk Factors ,Health care ,medicine ,Humans ,030212 general & internal medicine ,education ,Child ,Retrospective Studies ,education.field_of_study ,Framingham Risk Score ,business.industry ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Infant ,Community Health Centers ,Health Care Costs ,Risk adjustment ,Family medicine ,Child, Preschool ,Cohort ,Ambulatory ,0305 other medical science ,business - Abstract
Risk-stratification strategies are needed for ambulatory pediatric populations. The authors sought to develop age-specific risk scores that predict high health care costs among an urban population. A retrospective cohort study was performed of children ages 1-18 years who received care at Fair Haven Community Health Care (FHCHC), a community health center in New Haven, Connecticut. Cost was estimated from charges in the electronic health record (EHR), which is shared with the only hospital system in the city. Using multivariable logistic regression models, independent predictors of being in the top decile of total charges during the 2017 calendar year were identified, drawing from covariates collected from the EHR prior to 2017. Random forest modeling was used to verify the feature importance of significant covariates and model performance from 2017 cost data were compared to those using 2018 cost data. Regression models were used to construct age-specific nomograms to predict cost. Among 8960 children who received care at FHCHC in the 18 months prior to 2017, covariate frequencies clustered in age groups 1-5 years, 6-11 years, and 12-18 years, so 3 age-specific models were constructed. Prior utilization variables predicted future costs, as did younger children who received specialty care and older children with behavioral health diagnoses. Final models for each age group had C statistics ≥0.68 using both 2017 and 2018 cost data. Prediction models can draw from elements accessible in the EHR to predict cost of ambulatory pediatric patients. Strategies to impact utilization among high-risk children are needed.
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- 2020
21. Screening for Social Determinants of Health Among Children: Patients' Preferences for Receiving Information to Meet Social Needs and a Comparison of Screening Instruments
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Sofia I. Morales, Meghan Casey, Amanda DeCew, Benjamin J. Oldfield, and Douglas P. Olson
- Subjects
medicine.medical_specialty ,Adolescent ,Leadership and Management ,Social Determinants of Health ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Patient Preference ,03 medical and health sciences ,0302 clinical medicine ,Cross-Sectional Studies ,Community health center ,Family medicine ,Child, Preschool ,Social needs ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Social determinants of health ,0305 other medical science ,Psychology ,Referral and Consultation - Abstract
To characterize optimal strategies for screening for social determinants of health (SDOH) among children, the authors performed a cross-sectional study of parents and adolescents ages ≥13 years in a community health center. Participants were queried about how they prefer to receive information about social needs resources and 2 screening instruments were compared: Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education (WE CARE) and Accountable Health Communities (AHC). In July 2019, 154 parents and 21 adolescents were surveyed. Surveys were administered via tablet and required 5.6 minutes (standard deviation [SD] 3.9 minutes) for parents and 3.9 minutes (SD 1.4 minutes) for adolescents to complete. Parents identified technology (text message, email) and informational printouts as preferred mechanisms for information receipt (58% and 32% of participants, respectively); adolescents preferred text message (57%) and printouts (19%). Few (10% overall) preferred in-person consultation with a care coordinator. Adolescent/parent pairs (n = 19 pairs) agreed, on average across SDOH, 82% of the time for WE CARE and 85% for AHC. AHC elicited more positive screens than WE CARE for housing insecurity (12% of parents versus 7%) and food insecurity (47% versus 16%) but fewer positive screens than WE CARE for difficulties paying for utilities (27% versus 39%). Routine screening for SDOH in children requires 2-3 minutes per screening instrument. Screening can target parents of young children and either adolescents themselves or their parents. Families prefer to receive information about meeting social needs via technologically-based methods as opposed to in-person consultation with enabling services providers.
- Published
- 2020
22. Patient, Family, and Community Advisory Councils in Health Care and Research: a Systematic Review
- Author
-
Ann Greene, Marjorie S. Rosenthal, Marcus A Harrison, Inginia Genao, Benjamin J. Oldfield, Janis Glover, and Mary Ellen Pappas
- Subjects
medicine.medical_specialty ,Community engagement ,business.industry ,010102 general mathematics ,MEDLINE ,PsycINFO ,CINAHL ,01 natural sciences ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Systematic review ,Randomized controlled trial ,law ,Family medicine ,Health care ,Internal Medicine ,Medicine ,Observational study ,030212 general & internal medicine ,0101 mathematics ,business - Abstract
Patient-centeredness is a characteristic of high-quality medical care and requires engaging community members in health systems’ decision-making. One key patient engagement strategy is patient, family, and community advisory boards/councils (PFACs), yet the evidence to guide PFACs is lacking. Systematic reviews on patient engagement may benefit from patient input, but feasibility is unclear. A team of physicians, researchers, and a PFAC member conducted a systematic review to examine the impact of PFACs on health systems and describe optimal strategies for PFAC conduct. We searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and Social Science Citation Index from inception through September 2016, as well as pre-identified websites. Two reviewers independently screened and abstracted data from studies, then assessed randomized studies for risk of bias and observational studies for quality using standardized measures. We performed a realist synthesis—which asks what works, for whom, under what circumstances—of abstracted data via 12 monthly meetings between investigators and two feedback sessions with a hospital-based PFAC. Eighteen articles describing 16 studies met study criteria. Randomized studies demonstrated moderate to high risk of bias and observational studies demonstrated poor to fair quality. Studies engaged patients at multiple levels of the health care system and suggested that in-person deliberation with health system leadership was most effective. Studies involving patient engagement in research focused on increasing study participation. PFAC recruitment was by nomination (n = 11) or not described (n = 5). No common measure of patient, family, or community engagement was identified. Realist synthesis was enriched by feedback from PFAC members. PFACs engage communities through individual projects but evidence of their impact on outcomes is lacking. A paucity of randomized controlled trials or high-quality observational studies guide strategies for engagement through PFACs. Standardized measurement tools for engagement are needed. Strategies for PFAC recruitment should be investigated and reported. PFAC members can feasibly contribute to systematic reviews. A protocol for record eligibility was developed a priori and was registered in the PROSPERO database of systematic reviews (registration number CRD42016052817). The Department of Veterans Affairs’ Office of Academic Affiliations, through the National Clinician Scholars Program, funded this study.
- Published
- 2018
23. Office-Based Addiction Treatment in Primary Care
- Author
-
E. Jennifer Edelman, Jeanette M. Tetrault, and Benjamin J. Oldfield
- Subjects
medicine.medical_specialty ,business.industry ,Psychological intervention ,Specialty ,Opioid use disorder ,General Medicine ,Alcohol use disorder ,medicine.disease ,Health equity ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Multidisciplinary approach ,Family medicine ,medicine ,030212 general & internal medicine ,business ,030217 neurology & neurosurgery ,Buprenorphine ,medicine.drug - Abstract
Primary care is an important setting for delivering evidence-based treatment to address substance use disorders. To date, effective approaches to treat, care largely incorporate pharmacotherapy with counseling-based interventions and rely on multidisciplinary teams. There is strong support for primary care-based approaches to address alcohol and opioid use disorder with growing data focused on people living with human immunodeficiency virus and those experiencing incarceration. Future work should focus on the implementation of these effective approaches to decrease health disparities among people with substance use and to identify optimal approaches to address substance use in primary care and specialty settings.
- Published
- 2018
24. Using Narrative Medicine to Build Community Across the Health Professions and Foster Self-Care
- Author
-
Leonard Feldman, Benjamin J. Oldfield, and Lauren C. Small
- Subjects
Advanced and Specialized Nursing ,Narrative medicine ,education.field_of_study ,Radiological and Ultrasound Technology ,Social work ,business.industry ,Reflective practice ,05 social sciences ,Personal development ,Narrative inquiry ,03 medical and health sciences ,Emotional labor ,0302 clinical medicine ,Nursing ,0502 economics and business ,Health care ,Medicine ,030212 general & internal medicine ,business ,education ,050203 business & management ,Qualitative research - Abstract
Narrative medicine is a multidisciplinary field of inquiry and practice based on the premise that medical care takes place in the context of stories: the stories patients tell their providers, the stories providers tell each other, and the stories providers tell themselves about the work they do. Research on physicians and medical students suggests that training in narrative medicine conveys benefits, such as improved communication skills, personal growth, and job satisfaction. The role of narrative medicine in interprofessional groups has been less explored. In 2014, we started an interprofessional narrative medicine program in the Children's Center of the Johns Hopkins Hospital called AfterWards. Through literature, art, and writing, we endeavored to nurture empathy, encourage reflective practice, and build community among a diverse group of health care providers: nurses, social workers, attending physicians, residents, fellows, and child life specialists. The program meets monthly and is open to all on a volunteer drop-in basis. After 18 months, we conducted interviews of a purposeful sample of our attendees for reasons of quality improvement and to assess the program's impact. Our findings suggest that narrative medicine might have unique benefits for interprofessional teams. In a hospital environment that is often hierarchical and siloed, attending a narrative medicine group reduces isolation among health care providers, makes them feel equally valued, and provides a platform to hear diverse perspectives. By moderating the stress that arises from the emotional labor of hospital work, narrative medicine may also enhance self-care. Here, we report on our program's structure, summarize findings from our qualitative study, and provide perspectives from two nursing participants.
- Published
- 2017
25. Update on the Feasibility, Acceptability, and Impact of Group Well-Child Care
- Author
-
Tumaini R. Coker, Benjamin J. Oldfield, and Marjorie S. Rosenthal
- Subjects
medicine.medical_specialty ,Primary Health Care ,business.industry ,Group (mathematics) ,Child Health Services ,Primary health care ,Infant ,Patient Acceptance of Health Care ,Group Processes ,Appointments and Schedules ,Patient Education as Topic ,Child, Preschool ,Family medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Well child ,Child ,business - Published
- 2020
26. Opioid overdose prevention education for medical students: Adopting harm reduction into mandatory clerkship curricula
- Author
-
Benjamin J. Oldfield, Kirsten M. Wilkins, E. Jennifer Edelman, Noah A. Capurso, and Jeanette M. Tetrault
- Subjects
medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Prevention education ,Medicine (miscellaneous) ,Mandatory Programs ,Education ,Harm Reduction ,Naloxone ,medicine ,Curriculum ,Harm reduction ,Education, Medical ,business.industry ,Public health ,Opioid-Related Disorders ,Clinical Clerkship ,Opioid overdose ,medicine.disease ,Psychiatry and Mental health ,Opiate Overdose ,Harm ,Family medicine ,business ,medicine.drug - Abstract
Background Opioid overdose deaths constitute a public health crisis in the United States. Strategies for reducing opioid-related harm are underutilized due in part to clinicians’ low knowledge about harm reduction theory and limited preparedness to prescribe naloxone. Educational interventions are needed to improve knowledge and attitudes about, and preparedness to address, opioid overdoses among medical students. Methods Informed by the Department of Veterans Affairs’ Overdose Education and Naloxone Distribution (OEND) program and narrative medicine, we developed and led a mandatory workshop on harm reduction for clerkship medical students. Using validated scales, we assessed students’ knowledge and attitudes about, and preparedness to address, opioid overdoses before the workshop and 6 weeks after. Results Of 75 participating students from February through December 2017, 55 (73%) completed pre-workshop and 38 (51%) completed both pre- and post-workshop surveys. At baseline, 40 (73%) encountered patients with perceived at-risk opioid use in the previous 6 weeks, but only 11 (20%) recalled their teams prescribing naloxone for overdose prevention. Among those completing both surveys, knowledge about and preparedness to prevent overdose showed large improvement (Cohen's d = 0.85, P Discussion Educational interventions grounded in harm reduction theory can increase students’ knowledge and attitudes about, and preparedness to address, opioid overdoses.
- Published
- 2019
27. Integration of care for HIV and opioid use disorder
- Author
-
Benjamin J. Oldfield, Nicolas Muñoz, Melissa Funaro, E. Jennifer Edelman, Jeanette M. Tetrault, Merceditas Villanueva, and Mark P. McGovern
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Ovid medline ,Immunology ,Treatment outcome ,MEDLINE ,Human immunodeficiency virus (HIV) ,Medication adherence ,Directive Counseling ,HIV Infections ,PsycINFO ,medicine.disease_cause ,Article ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Behavior Therapy ,medicine ,Opiate Substitution Treatment ,Immunology and Allergy ,Humans ,030212 general & internal medicine ,Randomized Controlled Trials as Topic ,business.industry ,Opioid use ,Opioid use disorder ,medicine.disease ,Opioid-Related Disorders ,Analgesics, Opioid ,030104 developmental biology ,Infectious Diseases ,Treatment Outcome ,Family medicine ,business - Abstract
OBJECTIVE: We sought to identify optimal strategies for integrating HIV- and opioid use disorder-(OUD) screening and treatment in diverse settings. DESIGN: Systematic review. METHODS: We searched Ovid MEDLINE, PubMed, Embase, and PsycINFO and pre-identified websites. Studies were included if they were published in English on or after 2002 through May 2017, and evaluated interventions that integrated, at an organizational level, screening and/or treatment for HIV and OUD in any care setting in any country. RESULTS: Twenty-nine articles met criteria for inclusion, including 23 unique studies: six took place in HIV care settings, 12 in opioid treatment settings, and five elsewhere. Eight involved screening strategies, 22 involved treatment strategies, and seven involved strategies that encompassed screening and treatment. Randomized controlled studies demonstrated low to moderate risk of bias and observational studies demonstrated fair to good quality. Studies in HIV care settings (n=6) identified HIV- and OUD-related clinical benefits with the use of buprenorphine/naloxone for OUD. No studies in HIV care settings focused on screening for OUD. Studies in opioid treatment settings (n=12) identified improving HIV screening uptake and clinical benefits with antiretroviral therapy when provided on-site. Counseling intensity for OUD medication adherence or HIV-related risk reduction was not associated with clinical benefits. CONCLUSION: Screening for HIV can be effectively delivered in opioid treatment settings, yet there is a need to identify optimal OUD screening strategies in HIV care settings. Strategies integrating the provision of medications for HIV and for OUD should be expanded and should not be contingent on resources available for behavioral interventions. REGISTRATION: A protocol for record eligibility was developed a priori and was registered in the PROSPERO database of systematic reviews (registration number CRD42017069314).
- Published
- 2019
28. Addiction Screening—The A Star Is Born Movie Series and Destigmatization of Substance Use Disorders
- Author
-
Jeanette M. Tetrault, Benjamin J. Oldfield, and Gretchen Berland
- Subjects
Stereotyping ,medicine.medical_specialty ,Substance-Related Disorders ,business.industry ,Addiction ,media_common.quotation_subject ,Motion Pictures ,Medicine in the Arts ,MEDLINE ,Historical Article ,General Medicine ,History, 20th Century ,medicine.disease ,History, 21st Century ,Behavior, Addictive ,medicine ,Humans ,Substance use ,Addictive behavior ,business ,Psychiatry ,media_common - Published
- 2021
29. 10 Practice Recommendations in Adult Vaccination Administration
- Author
-
Benjamin J. Oldfield and Rosalyn W. Stewart
- Subjects
medicine.medical_specialty ,business.industry ,General Medicine ,Primary care ,Meningococcal vaccine ,Preventive care ,Vaccination ,Family medicine ,Common knowledge ,Medicine ,Young adult ,business ,Administration (government) ,Preventive healthcare - Abstract
Although the provision of immunoprophylaxis to children has become routine in the practice of pediatric preventive care, the same is not true in adult primary care. Contributing to this problem is a lack of knowledge among providers of adult preventive care. This review aimed to bolster providers' understanding of adult vaccinations by highlighting changes in vaccination recommendations and addressing common knowledge gaps. This is not a comprehensive list of vaccination recommendations, but rather the "top 10" common misconceptions, advancements, and updates we have found in our reading of the vaccination literature and in our own experience in a training institution.
- Published
- 2016
30. Inpatient adoption of medications for alcohol use disorder: A mixed-methods formative evaluation involving key stakeholders
- Author
-
E. Jennifer Edelman, Benjamin J. Oldfield, Gretchen Berland, Patrick G. O'Connor, Kimberly A. Yonkers, and Paul J. Joudrey
- Subjects
Pharmacology ,medicine.medical_specialty ,Harm reduction ,Social work ,Pharmacist ,Psychological intervention ,Alcohol use disorder ,Toxicology ,medicine.disease ,Focus group ,Article ,Formative assessment ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Family medicine ,medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Implementation research ,Psychology ,030217 neurology & neurosurgery - Abstract
Background Although the inpatient setting presents an important opportunity for medications for alcohol use disorder (MAUD) adoption, this infrequently occurs. We aimed to develop a comprehensive understanding of barriers and facilitators of inpatient MAUD adoption. Methods A convergent mixed-method study conducted from April to September 2018 of non-prescribing (registered nurse, pharmacist, and social work) and prescribing (physician or advanced practice provider hospitalist, general internist, and psychiatrist) professionals at a large urban academic medical center. Survey assessed organizational readiness to adopt MAUD and focus groups guided by the Consolidated Framework for Implementation Research (CFIR) analyzed using directed content analysis. Results Fifty-seven participants completed surveys and one of seven focus groups. Health professionals perceived clinical evidence (mean 4.0, 95 % confidence interval [CI]: 3.9, 4.2) as supportive and patient preferences (mean 3.4, 95 % CI: 3.2, 3.6) and availability of resources (mean 3.1, 95 % CI: 2.8, 3.3) as less supportive of MAUD adoption. Stakeholders identified barriers across CFIR constructs; 1) Intervention characteristics: limited knowledge of MAUD effectiveness and concerns about side effects, 2) Outer setting: perceived patient vulnerability to care interruptions and a lack of external incentives, 3) Inner setting: a lack of organizational prioritization, and 4) Characteristics of individuals: stigma of people with AUD. Facilitators included: 1) Intervention characteristics: adaptation of workflows and 2) Characteristics of individuals: harm reduction as treatment goal. Conclusions This study identified multiple intersecting barriers and facilitators of inpatient MAUD adoption. Implementation interventions should prioritize strategies that increase health professional knowledge of MAUD and organizational prioritization of treating AUD.
- Published
- 2020
31. Multimodal Treatment Options, Including Rotating to Buprenorphine, Within a Multidisciplinary Pain Clinic for Patients on Risky Opioid Regimens: A Quality Improvement Study
- Author
-
Ajay Manhapra, William C. Becker, Benjamin J. Oldfield, Sara N. Edmond, Alicia Agnoli, Curtis Bone, Dana J Cervone, John J. Sellinger, and Ellen L. Edens
- Subjects
Male ,medicine.medical_specialty ,Partial agonist ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,business.industry ,Chronic pain ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Quality Improvement ,Buprenorphine ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Pain Clinics ,Opioid ,Emergency medicine ,Female ,Neurology (clinical) ,Chronic Pain ,business ,030217 neurology & neurosurgery ,Cohort study ,medicine.drug - Abstract
Objectives We aimed to evaluate a novel clinical program designed to address unsafe use of opioids prescribed for pain-the Opioid Reassessment Clinic (ORC)-to inform practice and health system improvement. Design Controlled, retrospective cohort study. Setting The ORC is a multidisciplinary clinic in a primary care setting in a Veterans Health Administration hospital designed to perform longitudinal treatment of patients with unsafe use of opioids prescribed for pain, including tapering or rotating to the partial opioid agonist buprenorphine. Subjects We included patients referred to the ORC from March 1, 2016, to March 1, 2017, who had an intake appointment (intervention group) and who did not (control group). Methods We compared a priori-defined metrics at the patient, clinic process, and health system levels and compared metrics between groups. Results During the study period, 114 veterans were referred to the ORC, and 71 (62%) of these had an intake appointment. Those in the intervention group were more likely to trial buprenorphine (N = 41, 62% vs N = 1, 2%, P
- Published
- 2018
32. 'No more falling through the cracks': A qualitative study to inform measurement of integration of care of HIV and opioid use disorder
- Author
-
Mark P. McGovern, E. Jennifer Edelman, Nicholas Boshnack, Benjamin J. Oldfield, Nicolas Muñoz, Robert Leavitt, Jeanette M. Tetrault, and Merceditas Villanueva
- Subjects
Counseling ,Male ,Community-Based Participatory Research ,Service delivery framework ,Medicine (miscellaneous) ,Community-based participatory research ,Participatory action research ,HIV Infections ,Comorbidity ,Nursing ,Harm Reduction ,medicine ,Opiate Substitution Treatment ,Humans ,Qualitative Research ,Delivery of Health Care, Integrated ,Opioid use disorder ,Focus Groups ,Middle Aged ,medicine.disease ,Opioid-Related Disorders ,Focus group ,Integrated care ,Psychiatry and Mental health ,Clinical Psychology ,Anti-Retroviral Agents ,Female ,Health Services Research ,Pshychiatric Mental Health ,Psychology ,Psychosocial ,Qualitative research - Abstract
Introduction Integration of HIV- and opioid use disorder (OUD)-related care is associated with improved patient outcomes. Our goal was to develop a novel instrument for measuring quality of integration of HIV and OUD-related care that would be applicable across diverse care settings. Methods Grounded in community-based participatory research principles, we conducted a qualitative study from August through November 2017 to inform modification of the Behavioral Health Integration in Medical Care (BHIMC) instrument, a validated measure of quality of integration of behavioral health in primary care. We conducted semi-structured interviews of patients (n = 22), focus groups with clinical staff (n = 24), and semi-structured interviews of clinic leadership (n = 5) in two urban centers in Connecticut. Results We identified three themes that characterize optimal integration of HIV- and OUD-related care: (1) importance of mitigating mismatches in resources and knowledge, particularly resources to address social risks and knowledge gaps about evidence-based treatments for OUD; (2) need for patient-centered policies and inter-organization communication, and (3) importance of meeting people where they are, geographically and at their stage of change. These themes highlighted aspects of integrated care for HIV and OUD not captured in the original BHIMC. Conclusions Patients, clinical staff, and organization leadership perceive that addressing social risks, communication across agencies, and meeting patients in their psychosocial and structural context are important for optimizing integration of HIV and OUD-related care. Our proposed, novel instrument is a step towards measuring and improving service delivery locally and nationally for this vulnerable population.
- Published
- 2018
33. Office-Based Addiction Treatment in Primary Care: Approaches That Work
- Author
-
E Jennifer, Edelman, Benjamin J, Oldfield, and Jeanette M, Tetrault
- Subjects
Substance Abuse Detection ,Alcoholism ,Cognitive Behavioral Therapy ,Primary Health Care ,Substance-Related Disorders ,Narcotic Antagonists ,Amphetamine-Related Disorders ,Opiate Substitution Treatment ,Humans ,Opioid-Related Disorders ,Combined Modality Therapy - Abstract
Primary care is an important setting for delivering evidence-based treatment to address substance use disorders. To date, effective approaches to treat, care largely incorporate pharmacotherapy with counseling-based interventions and rely on multidisciplinary teams. There is strong support for primary care-based approaches to address alcohol and opioid use disorder with growing data focused on people living with human immunodeficiency virus and those experiencing incarceration. Future work should focus on the implementation of these effective approaches to decrease health disparities among people with substance use and to identify optimal approaches to address substance use in primary care and specialty settings.
- Published
- 2018
34. News Media Recommendations for Opioid Disposal: Keeping Flush with the Guidelines?
- Author
-
Benjamin J. Oldfield and William C. Becker
- Subjects
Prescription Drugs ,business.industry ,Communication ,MEDLINE ,General Medicine ,medicine.disease ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Opioid ,Medicine ,Mass Media ,Neurology (clinical) ,Medical emergency ,business ,News media ,Mass media ,medicine.drug - Published
- 2019
35. A Piece of My Mind: Coauthors
- Author
-
Benjamin J, Oldfield and Paula R, Duvall
- Subjects
Physician-Patient Relations ,Narration ,Personal Autonomy ,Patient Care Planning - Published
- 2016
36. Authors' Response
- Author
-
Benjamin J. Oldfield and Rosalyn W. Stewart
- Subjects
General Medicine - Published
- 2016
37. Coauthors
- Author
-
Paula R Duvall and Benjamin J. Oldfield
- Subjects
0301 basic medicine ,03 medical and health sciences ,030109 nutrition & dietetics ,0302 clinical medicine ,Psychoanalysis ,business.industry ,Medicine ,Narrative ,030212 general & internal medicine ,General Medicine ,Personal autonomy ,business - Published
- 2016
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