Browsing by Author "Hartman, David"
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- Screening, brief intervention, and referral to treatment (SBIRT) training reduces stigma and prepares orthopaedic providers to identify and intervene in opioid misuse: a prospective cohort studyMierisch, Cassandra; Hartman, Cheryl; Quinn, Caleb; Hartman, David (Lippincott Williams & Wilkins, 2022-03)Background: Despite the evolution of responsible opioid prescription for musculoskeletal pain, patients remain at risk for opioid problematic use, misuse, and addiction. Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based practice to identify, reduce, and prevent those outcomes. This pilot study investigated the use of SBIRT practices developed to target opioid misuse in the orthopaedic practice environment and its applicability in the orthopaedic population. Methods: In this prospective cohort study, 19 orthopaedic providers underwent SBIRT training. Participants reported on their use of SBIRT over 6 wk and completed the Medical Condition Regard Scale (MCRS). Results: Twelve participants successfully implemented SBIRT, screening an average of 58.5% of patients. Seventeen percent of patients screened to an elevated risk level. Patients who screened as medium or high risk were 5.8 and 8.4 times more likely, respectively, to receive intervention compared with patients who screened to low risk or not screened (P<0.01). Regard for patients with opioid use for pain increased from an MCRS score of 44.6 to 52.5 (P<0.01). Ninety-five percent of participants found the training useful, and 89% would recommend the training to a colleague. Conclusions: This study demonstrated integration of SBIRT practices into an orthopaedic environment in which a significant proportion of orthopaedic patients screened to elevated risk of opioid misuse and qualified for brief intervention by the orthopaedic provider. SBIRT training had a positive impact on opioid-use stigma, a recognized barrier to care. Further study is warranted to determine the effect on patient outcomes and optimal implementation strategy.
- Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorderTruong, Albert Y.; Saway, Brian F.; Bouzaher, Malek H.; Rasheed, Mustafa N.; Monjazeb, Sanaz; Everest, Soleille D.; Giampalmo, Susan L.; Hartman, David; Hartman, Cheryl; Kablinger, Anita S.; Trestman, Robert L. (2021-01-10)Background Clinical trials provide consistent evidence for buprenorphine’s efficacy in treating opioid use disorder (OUD). While the Drug Addiction Treatment Act of 2000 requires physicians to combine medication-assisted treatment (MAT) with behavioral intervention, there is no clear evidence for what form or elements of psychotherapy are most effective when coupled with MAT to treat OUD. This investigation involves focus groups designed to collect patient opinions about a specific psychotherapy, called START NOW, as well as general beliefs about various elements of psychotherapy for treating OUD. Our analysis reveals trends about patient preferences and strategies for improving OUD treatment. Methods Subjects included patients enrolled in buprenorphine/naloxone MAT at our institution’s office-based opioid treatment program. All subjects participated in a single START NOW group session, which was led by a provider (physician or nurse practitioner trained and standardized in delivering START NOW). Consented subjects participated in satisfaction surveys and audio-recorded focus groups assessing individual beliefs about various elements of psychotherapy for treating OUD. Results Overall, 38 different focus groups, 92 participation events, and 44 unique subjects participated in 1-to-6 different START NOW session/audio-recorded focus group sessions led by a certified moderator. Demographic data from 36/44 subjects was collected. Seventy-five percent (33/44) completed the START NOW Assessment Protocol, which revealed self-reported behavioral trends. Analysis of all 92 START NOW Satisfaction Questionnaire results suggests that subjects’ opinions about START NOW improved with increased participation. Our analysis of audio-recorded focus groups is divided into three subsections: content strategies for new psychotherapies, implementation strategies, and other observations. For example, participants request psychotherapies to target impulsivity and to teach future planning and build positive relationships. Conclusions The results of this study may guide implementation of psychotherapy and improve the treatment of OUD, especially as it relates to improving the modified START NOW program for treating OUD. Our study also reveals a favorable outlook of START NOW with increased participation, suggesting that any initial reticence to this program can be overcome to allow for effective implementation.